Recommendations from an International Consensus Conference on the Current Status and Future of Neoadjuvant Systemic Therapy in Primary Breast Cancer

Abstract

The use of neoadjuvant systemic therapy (NST) for the treatment of primary breast cancer has constantly increased, especially in trials of new therapeutic regimens. In the 1980 s, NST was shown to substantially improve breast-conserving surgery rates and was first typically used for patients with inoperable locally advanced or inflammatory breast cancer. Investigators have since also used NST as an in vivo test for chemosensitivity by assessing pathologic complete response. Today, by using pathologic response and other biomarkers as intermediate end points, results from trials of new regimens and therapies that use NST are aimed to precede and anticipate the results from larger adjuvant trials. In 2003, a panel of representatives from various breast cancer clinical research groups was first convened in Biedenkopf to formulate recommendations on the use of NST. The obtained consensus was updated in two subsequent meetings in 2004 and 2006. The most recent conference on recommendations on the use of NST took place in 2010 and forms the basis of this report.

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

“…Indeed, TNBC is associated with higher risk of distant recurrence and death, especially within the first 3 years after diagnosis (8,25). It is thus extremely important to identify the clinicobiologic, molecular, or imaging biomarkers that can early predict which TNBC tumors will respond to NAC.…”

Prognostic significance of pathologic complete response and Ki67 expression after neoadjuvant chemotherapy in breast cancer

“…Generally, any patient who is a candidate for adjuvant chemotherapy can be considered for neoadjuvant chemotherapy [1,2]. The main expected benefit from neoadjuvant chemotherapy is reduction of the extent of surgery.…”

Breast Conservation Surgery after Neoadjuvant Chemotherapy in Responders in Operable Breast Carcinoma: A Better Alternative.

“…Use of neoadjuvant chemotherapy is common approach in stage II and III operable breast cancer [19] and the authors found that with proper selection criteria and multidisciplinary coordination excellent local control rates could be achieved in responders who otherwise were candidates for MRM . [20] …”