Evidence-Based Use of Neoadjuvant Taxane in Operable and Inoperable Breast Cancer

Abstract

Neoadjuvant chemotherapy (NC) is standard therapy for patients with locally advanced breast cancer and is increasingly used for early-stage operable disease. The aim of NC is a pathological complete response (pCR) in the breast and axillary lymph nodes, which is the best predictor of improved outcome and prolonged survival. The taxanes docetaxel and paclitaxel are potent agents in breast cancer management, with promising single-agent activity and acceptable tolerability in the neoadjuvant setting. In this review of the taxanes as NC for operable and inoperable breast cancer, we include all fully published Phase II-III studies enrolling >30 patients. Current evidence suggests that the sequential administration of taxane-and anthracycline-based therapy may be superior to concomitant administration. Indeed, until the recent Phase III Aberdeen study (n ‫؍‬ 162), it was uncertain whether NC could prolong survival. In this study, sequential docetaxel after anthracycline-based NC significantly enhanced the clinical response rate and pathological complete response, and yielded a significant 3-year survival advantage, versus anthracyclinebased NC alone. Recently, the Phase III National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B27 trial (n ‫؍‬ 2411) showed that sequential docetaxel after doxorubicin-cyclophosphamide significantly increased both clinical and pathological response rates for operable breast cancer, with the benefit evident in both estrogen receptorpositive and estrogen receptor-negative patients. This apparent superiority of a sequential anthracycline-taxane regimen is limited to docetaxel, with no similar Phase III trials of paclitaxel versus a non-taxane-based comparator having been conducted to date. In conclusion, current evidence supports the inclusion of a taxane in NC schedules for patients with large and locally advanced breast cancer.

A phase II study of sequential neoadjuvant gemcitabine plus doxorubicin followed by gemcitabine plus cisplatin in patients with operable breast cancer: prediction of response using molecular profiling

“…Although the effectiveness of neoadjuvant chemotherapy vs adjuvant chemotherapy in locally advanced breast cancer remains controversial (Estévez and Gradishar, 2004;Cianfrocca and Gradishar, 2005), general findings indicate that both approaches result in equivalent disease-free survival and overall survival (Scholl et al, 1994;Fisher et al, 1998;van der Hage et al, 2001). Clinical trial results indicate that 60 -80% of women who receive neoadjuvant chemotherapy have a clinical response, and 10 -20% achieve a pathological complete response (pCR) (Cianfrocca and Gradishar, 2005).…”

Prediction of high-risk patients by genome-wide copy number alterations from remaining cancer after neoadjuvant chemotherapy and surgery

“…In view of the accepted adjuvant treatment in patients with residual tumor after neoadjuvant chemotherapy and surgery (32), it would be useful to identify patients with tumors at a high risk of recurrence for treatment with a non cross-resistant adjuvant regimen as we do in osteosarcoma. When we compared the gene set I for the survival prediction after surgery with known clinical factors, it was found to be an independent factor for the prediction.…”

Neoadjuvant combination therapy with trastuzumab in a breast cancer patient with synchronous rectal carcinoma: a case report and biomarker study

“…In addition, neoadjuvant therapy (mostly chemotherapy) is often administered in patients with clinically operable breast carcinoma [1,2]. The data from randomized clinical trials as well as a meta-analysis show that the neoadjuvant or adjuvant administration of chemotherapy results in similar survival outcomes [3][4][5][6].…”