Trends and Novel Approaches in Neoadjuvant Treatment of Breast Cancer

Abstract

Breast cancer is the most prevalent malignant disease in women worldwide. Traditionally, surgical tumour resection was the primary step within the treatment algorithm of early stage disease; systemic therapy in order to reduce the rate of systemic recurrences followed. National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-18 found that pre- and postoperative administration of chemotherapy was equally effective. This study therefore established neoadjuvant chemotherapy as a valid treatment option, as the breast conservation rate is increased. Modern neoadjuvant regimens encompassing anthracyclines and taxanes yield pathological complete response (pCR) rates of around 20%, with higher efficacy observed in triple-negative tumours. The antibody trastuzumab is the first targeted agent established in neoadjuvant regimens for the treatment of Her2-positive breast cancer, as it raised pCR rates up to 50%. Novel approaches are aiming to increase the efficacy of neoadjuvant therapy. Inclusion of capecitabine might further increase pCR rates in selected patients, although data are not unanimous throughout the respective clinical trials. In patients harbouring BRCA-1 germline mutations, platinum derivatives are apparently promising. Novel Her2-targeted agents such as lapatinib and pertuzumab are currently under investigation in several clinical trials, while the role of bevacizumab, a monoclonal antibody inhibiting angiogenesis, awaits future clarification.

Expression of NK Cell Surface Receptors in Breast Cancer Tissue as Predictors of Resistance to Antineoplastic Treatment

“…Multimodal therapy, including chemotherapy, surgery, and radiation, is the treatment of choice that has shown the highest percentage survival in such patients with breast cancer. 4,5 Particularly, chemotherapeutic schemes based on anthracycline and taxanes are widely accepted as first alternatives in the treatment of breast cancer [6][7][8] ; these therapeutic strategies provide a benefit in recurrence-free survival as well as overall survival. 9,10 Management in clinical practice, using a neoadjuvant chemotherapy regimen in either a concomitant or sequential manner, is preferred in locally advanced breast cancer.…”

Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy

“…10,11 Although today the sequential administration of these agents is usually preferred, ABCSG trials 14 and 24 identified 6 cycles of concomitant ED (with or without capecitabine) as a potential neoadjuvant treatment standard. 12,13 Accordingly, in the present study, standardized NACT consisted of 6 cycles of ED administered intravenously once every 3 weeks (E 75 mg/m 2 and D 75 mg/m 2 ) with primary granulocyte colony-stimulating factor support.…”