Neoadjuvant therapy for breast cancer – pro

Lay Summary: Cliinical utility of neadjuvant chemotherapy is making breast cancer resectable or in limiting the extent of surgery required to resect.

Historically, neoadjuvant therapy was undertaken with the aim of shrinking the tumor in patients who were not candidates for primary surgery, and in the hope of allowing greater conservation of the breast. Evidence then emerged suggesting that induction of a pathological complete response (pCR) was at least to some extent predictive of long-term clinical response. Today, the research rationale is different: neoadjuvant therapy is viewed as a means of testing the activity of a therapeutic approach or the potential importance of biological factors in determining disease outcome. Patients can be treated de novo, results are available quickly, and valuable information can be gathered from proof-of-concept studies involving a relatively small number of patients. However, there is also a consensus that it is useful in decreasing cancer extent and enabling full resection. The main clinical aim of neoadjuvant (also called primary or preoperative) treatment for operable breast cancer before surgery is to downstage large cancers to reduce the need for mastectomy. Neoadjuvant systemic treatment was developed for women with locally advanced (inoperable) breast cancers. It is also used in women with large operable breast cancers to avoid mastectomy. In these women, neoadjuvant treatment is as effective as standard adjuvant treatment.

Breast Cancer Disease Site Group. Trudeau M, Sinclair S, Clemons M, Shelley W. The role of taxanes in neoadjuvant chemotherapy for women with non-metastatic breast cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Dec 10. 32 p. (Practice guideline report; no. 1-20). [53 references]

P. Spronk K. de Ligt A. van Bommel S. Siesling M-J. Vrancken Peeters C. Smorenburg. Neoadjuvant chemotherapy use in breast cancer patients in the Nethelands: an expert opinion on current practice

Trudeau M, Madarnas Y, McCready D, Pritchard KI, Messersmith H, Breast Cancer Disease Site Group. The role of trastuzumab in adjuvant and neoadjuvant therapy in women with HER2/neu-overexpressing breast cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 May 12. 28 p. (Evidence-based series; no. 1-24). [58 references], breast cancer

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