Cancer Treatment Today

Can breast cancer be treated with a limb-sparing approaches, as if  common in other cancer locations, such as laryngeal cancer? Neoadjuvant chemotherapy to enable a more limited breast surgery is a concept advocated by such illustrious European physicains as the late DonnaBonna. It is not the aproach that is widely used in the United States, however. Most US oncologists do not see the breast as a vital organ, to spare which, a neaodjuvant approach is justified. Neoadjuvant chemotherapy is usually used in the USA to render large and unresectable breast cancers operable. Another reason to use it, is to be able to predict cancer responsiveness to a particular drug combination, which can guide adjuvant therapy.

There is a consensus that neoadjuvant chemotherapy can achieve limited goals; the debate is about the value or benefits of such these achievements in  patients who could be operated with a wider resection without neaodjuvant chemotehrapy. This debate has many cultural and societal overttones that relate to the value of breast sparing and what cost/benefit ratio it justifies. The technology/ concept itself, however, is not experimental and is no longer being evaluated with trials.

However, the role of Avastin in neaodjuvant therapy is not clear as Avastin may be effective for adjuvant therapy and not to reduce the size of large breas masses neoadjuvantly. There is in fact a study: Neoadjuvant TAC Plus or Minus Bevacizumab(AVF3299), NCT00203372.

Neoadjuvant Chemotherapy in Operable Breast Cancer: The Pros
E.P. Mamounas Bresst Care Vol. 1, No. 6, 2006

Aapro, Matti S. Neoadjuvant Therapy in Breast Cancer: Can We Define Its Role?
Oncologist 2001 6: 36-39; doi:10.1634/theoncologist.6-suppl_3-36

A. Berruti, M. P. Brizzi, D. Generali, M. Ardine, L. Dogliotti, P. Bruzzi, and A. Bottini
Presurgical Systemic Treatment of Nonmetastatic Breast Cancer: Facts and Open Questions
Oncologist, November 1, 2008; 13(11): 1137 – 1148.