Approaching Neoadjuvant Therapy in the Management of Early-Stage Breast Cancer

Abstract

Neoadjuvant therapy is integral to the treatment of early-stage breast cancer. Goals of treatment include surgical downstaging of the tumor, rendering inoperable tumors resectable, and de-escalating axillary surgery in those with clinically positive nodes. Additionally, response to treatment provides important prognostic information regarding risk of recurrence and guides future adjuvant treatment. Although chemotherapy serves as the backbone of neoadjuvant treatment, an increased understanding of the tumor's clinical course as well as its molecular and genetic make-up aids in individualizing treatment and developing novel agents. This review summarizes current clinical approaches and the future direction to the management of breast cancer patients in the neoadjuvant setting.

Machine Learning Models and Multiparametric Magnetic Resonance Imaging for the Prediction of Pathologic Response to Neoadjuvant Chemotherapy in Breast Cancer

“…Globally, breast cancer (BC) is the most commonly diagnosed cancer and the most common cause of cancer death among women [ 1 ]. In the management of BC, neoadjuvant chemotherapy (NAC) has been well established for patients with large breast tumours, high-risk breast tumours and locally advanced tumours, including those initially ineligible for surgery [ 2 ]. Although different NAC regimens exist, anthracyclines followed by taxanes are widely used chemotherapeutic agents, as they have been demonstrated to significantly increase the rate of pathological complete response (pCR) [ 3 , 4 ].…”

Psychological Distress, Coping Strategies, and Quality of Life in Breast Cancer Patients Under Neoadjuvant Therapy: Protocol of a Systematic Review

“…It is routinely performed by immunohistochemical analyses in order to mark different subgroups and serve as biomarkers for therapeutic decisions. 2,3 Locally advanced breast cancer (LABC) represents a variety of tumors ranging from slow-growing cancer to rapidly proliferating and aggressive cancers. 4 LABC is defined by the size of the tumor that exceeds 50 mm, which implies the skin of the breast/chest wall, supra/infraclavicular lymph nodes, or multiple axillary lymph nodes.…”

“…15,16 It is based either on cycles of neoadjuvant chemotherapy (NACT) or neoadjuvant endocrine therapy (NET). 3,17 NACT was introduced in BC treatment in the 1970s 18,19 to reduce the stage of the LABC disease (inoperable) and make it operable. Anthracycline and taxane-based regimens are the standard primary NACT for LABC.…”

“…20 For HER2-positive BC, NACT includes administration of chemotherapy with anti-HER2 monoclonal antibodies, such as trastuzumab and pertuzumab. 3,21 While Neoadjuvant endocrine therapy (NET) may be beneficial for LABC patients with estrogen receptors (ER) positive or progesterone receptors (PR) positive since it can decrease the tumor size and improve breast-conserving surgery rates. 22 Two applications of NET are possible, the first inhibits the production of estrogen used by aromatase inhibitors (AI) including letrozole, anastrozole, and exemestane, or by luteinizing hormone-releasing hormone agonists in premenopausal women.…”

“…It is routinely performed by immunohistochemical analyses in order to mark different subgroups and serve as biomarkers for therapeutic decisions. 2,3…”