From the Guidelines
Patients receive chemotherapy prior to surgery, known as neoadjuvant chemotherapy, to reduce tumor burden, promptly treat possible metastatic disease, and potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response. This approach is particularly beneficial for patients with locally advanced invasive breast cancers, as it allows for breast conservation rather than mastectomy, and may improve disease-free survival rates for those who demonstrate a complete pathologic response to neoadjuvant chemotherapy 1. The primary aims of neoadjuvant chemotherapy are to:
- Reduce tumor burden, thereby permitting breast conservation rather than mastectomy
- Promptly treat possible metastatic disease, whether or not it is detectable on preoperative staging
- Potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response Neoadjuvant chemotherapy regimens, such as AC-T (Adriamycin/Cyclophosphamide followed by Taxol) for breast cancer, are typically administered over 2-6 months depending on the cancer type and response 1. Patients undergoing neoadjuvant chemotherapy should be aware of potential side effects, including fatigue, nausea, hair loss, and immune suppression, which may require supportive medications and careful monitoring.
The use of neoadjuvant chemotherapy is supported by recent studies, including a 2017 study published in the Journal of the American College of Radiology, which highlights the importance of accurate radiological assessment in managing patients with locally advanced breast cancer 1. Another study from 2017 also published in the Journal of the American College of Radiology, discusses the indications for neoadjuvant therapy, including T2 tumors, triple-negative tumors, and HER2/neu-positive tumors 1. Overall, neoadjuvant chemotherapy is a valuable treatment approach that can improve outcomes for patients with locally advanced breast cancer, and its use should be considered on a case-by-case basis, taking into account the individual patient's tumor characteristics, overall health, and treatment goals.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Reasons for Neoadjuvant Chemotherapy
- Neoadjuvant chemotherapy is administered prior to surgery to shrink tumors, making them easier to remove and increasing the likelihood of successful surgery 2, 3, 4.
- This approach allows for the assessment of the tumor's response to chemotherapy, helping to identify the most effective treatment strategy 2, 3, 4.
- Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery, improving cosmetic outcomes and reducing the need for more extensive surgical procedures 3, 5.
Benefits of Neoadjuvant Chemotherapy
- Achieving a pathological complete response (pCR) after neoadjuvant chemotherapy is associated with improved disease-free survival (DFS) and overall survival (OS) rates 2, 3.
- Neoadjuvant chemotherapy can downstage tumors, making them more operable and improving surgical outcomes 4, 5.
- This approach provides an opportunity to escalate adjuvant therapy in patients with residual disease after neoadjuvant chemotherapy, potentially improving long-term outcomes 4.