Neoadjuvant therapy for breast cancer

Abstract

The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy.

Variation of Breast Vascular Maps on Dynamic Contrast-Enhanced MRI After Primary Chemotherapy of Locally Advanced Breast Cancer

“…Medical neoadjuvant treatments are aimed at downsizing the cancer and exploring the in vivo chemosensitivity of the tumor cells [10,11,15,16]. For patients undergoing primary chemotherapy, the achievement of pathologic complete response is considered a surrogate marker for a favorable long-term clinical outcome [11,[17][18][19][20].…”

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

“…A few years ago, neoadjuvant chemotherapy was used only in locally advanced breast cancers that were deemed inoperable. 5 More recently, it has been increasingly used for tumors that are resectable, but the intent is to reduce the tumor size by neoadjuvant chemotherapy and subsequently remove a smaller portion of breast tissue than would otherwise be removed at primary surgery. [6][7][8] Breast cancer is a heterogeneous disease at morphological, immunohistochemical and even at molecular level.…”

Neoadjuvant Radiotherapy of Early-Stage and Locally Advanced Breast Cancer: Review of the Literature

“…It was recognized that multimodal therapy including; surgery, chemotherapy and radiotherapy can significantly improve outcomes in this select group of patients [29]. Neo-adjuvant chemotherapy integrated into this multimodality program is the conventional treatment in LABC [30,31]. Primary systemic over adjuvant therapy has the advantages of in vivo measurement of response to therapy, increased the chances of successful BCT as well as the reduction of microscopic neoplastic dissemination [31][32][33] The benefit of CCRT in the PCR rate and in local and distant disease control has made that modality the standard of care in a number of malignancies.…”