Primary Therapy in Breast Cancer: What Have We Learned from Landmark Trials?

Abstract

Primary anticancer therapy is currently accepted as a therapeutic option for patients with early-stage breast cancer. Its objectives are to increase the chance of achieving a conservative surgery and, similar to adjuvant chemotherapy, to reduce the risk of distant recurrence. The prognostic significance of obtaining a pathological complete response has been evaluated in several randomized clinical trials and meta-analyses. Growing evidence suggests that pathological complete response may act as a valid predictor of overall survival. Of note, a significant association between pathological complete response and outcome has especially been observed in patients with HER2-positive and triple-negative (hormonal receptors negative and HER2-negative) breast cancer. This review focuses on recent trials of neoadjuvant treatment with specific attention to HER2-negative disease. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Future Medicine Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/wh; (4) view/print certificate. Release date: 28 October 2013; Expiration date: 28 October 2014 Learning objectivesUpon completion of this activity, participants should be able to:• Distinguish tumor characteristics that are favorable for neoadjuvant therapy• Compare outcomes among women with breast cancer treated with neoadjuvant therapy vs postoperative therapy• Assess the primary chemotherapy regimen recommended in neoadjuvant therapy• Evaluate the use and outcomes of endocrine treatment as neoadjuvant therapy CMe part of

The addition of bevacizumab to neoadjuvant chemotherapy in HER2-negative inflammatory breast cancer, more not necessarily better

“…The poor prognosis of IBC is probably due to its high metastatic potential (3). The standard systemic management includes chemotherapy, in addition to anti-hormone and/or anti-human epidermal growth factor receptor-2 (anti-HER2) therapy, depending on the expression of the relevant receptors (3)(4)(5)(6)(7)(8). Angiogenesis is known to be required for proliferation of tumor cell (9,10), the activity of which is determined by the extent of micro vessel density (MVD), which may serve as a surrogate of aggressiveness of the breast cancer (9).…”