Neoadjuvant Therapy in Early Breast Cancer: Treatment Considerations and Common Debates in Practice

Abstract

Neoadjuvant treatment offers a number of benefits for patients with early breast cancer, and is an important option for consideration by multidisciplinary teams. Despite literature showing its efficacy, the use of neoadjuvant therapy varies widely. Here we discuss the clinical evidence supporting the use of neoadjuvant therapy in early stage breast cancer, including patient selection, monitoring response, surgery and radiotherapy considerations, with the aim of assisting multidisciplinary teams to determine patient suitability for neoadjuvant treatment.

Neoadjuvant chemotherapy in non‐metastatic breast cancer: a study on practice trends in a regional cancer treatment service

“…At present, the combination of an anthracycline and taxane containing regimen with or without HER2 targeted therapy remains the standard of care . Future directions may include further improvements in treatment efficacy by optimising treatment composition.…”

“…At present, the combination of an anthracycline and taxane containing regimen with or without HER2 targeted therapy remains the standard of care. 15 Future directions may include further improvements in treatment efficacy by optimising treatment composition. This may include the addition of agents such as platinum compounds, Pertuzumab, Cyclin-D Kinase 4/6 Inhibitors, and immune checkpoint inhibitors.…”

“…13 However, a recent metaanalysis by the European Breast Cancer Trialist Group (EBCTCG) on long-term outcomes documented higher loco-regional relapse in the NACT group even after the trials containing patients who did not undergo optimal surgical treatment were excluded. 14 Other limitations includes potential loss of pre-treatment staging information, the limited evidence base to guide adjuvant radiotherapy decisions for patients with residual disease, 15 the lack of international consensus in defining pCR and the absence of a standard system for reporting pathological response. 16 In the developed world, NACT rates are estimated to range between 7 and 27%.…”

Neoadjuvant endocrine therapy for luminal breast cancer treatment: a first-choice alternative in times of crisis, such as the COVID-19 pandemic

“…This strategy could be used for most cases of luminal-like breast cancer, even those with axillary positive nodes. A better response is expected when there is high ER expression (Allred score [6][7][8] or in luminal A phenotypes although our experience with over 150 patients shows that luminal B tumours respond almost as well.…”

“…Robust (although relatively small) trial data show preoperative endocrine treatment to be a safe option when compared to chemotherapy [4][5][6], with significantly lower toxicity. The rates of breast conserving surgery increase clearly with NET, reaching 60%-80% [7][8][9]. It should be noted that pathological complete response rates are quite low [1] (as with chemotherapy), although this does not appear to influence prognosis as much as happens with non-luminal tumours.…”