From the Guidelines
Neoadjuvant chemotherapy for breast cancer is typically recommended for patients with locally advanced breast cancer (stage II or III), inflammatory breast cancer, or those with large tumors relative to breast size who desire breast conservation surgery, as well as for patients with certain aggressive subtypes, such as triple-negative breast cancer or HER2-positive breast cancer, even in earlier stages. The decision to use neoadjuvant chemotherapy is based on the tumor's size, stage, and subtype, as well as the patient's overall health and preferences 1.
Key Indications for Neoadjuvant Chemotherapy
- Locally advanced breast cancer (stage II or III)
- Inflammatory breast cancer
- Large tumors relative to breast size
- Aggressive subtypes, such as triple-negative breast cancer or HER2-positive breast cancer
Goals of Neoadjuvant Chemotherapy
- Shrink tumors before surgery to allow for less extensive operations
- Assess tumor response to therapy in real-time
- Treat possible micrometastatic disease early
- Provide valuable prognostic information, as patients who achieve a pathologic complete response generally have better long-term outcomes 1
Treatment Regimens
- Anthracycline-based combinations (like doxorubicin and cyclophosphamide) followed by taxanes (paclitaxel or docetaxel)
- Targeted therapy with trastuzumab and pertuzumab for HER2-positive disease
Multidisciplinary Planning
Neoadjuvant therapy requires careful planning with medical oncology, surgery, and radiation oncology to coordinate optimal timing of treatments 1.
Recent Guidelines
The most recent guidelines, such as those from the St. Gallen International Consensus Guidelines for Treatment of Early Breast Cancer 2021, endorse preoperative systemic therapy as the preferred approach for women with stage II or III, HER2-positive or triple-negative cancers 1.
From the Research
Patient Selection for Neoadjuvant Chemotherapy
The decision to administer neoadjuvant chemotherapy for breast cancer is based on several factors, including the stage and type of cancer, as well as the patient's overall health.
- Patients with locally advanced or inoperable breast cancer, such as inflammatory breast cancer, are often considered for neoadjuvant chemotherapy 2, 3, 4.
- Those with early-stage, operable breast cancer may also be candidates for neoadjuvant chemotherapy, particularly if they have aggressive phenotype breast cancer 2.
- The goal of neoadjuvant chemotherapy is to shrink the tumor, making it easier to remove surgically, and to assess the individual's response to the treatment 2, 4.
Types of Breast Cancer Treated with Neoadjuvant Chemotherapy
Neoadjuvant chemotherapy can be used to treat various types of breast cancer, including:
- HER2-positive early breast cancer, where anthracycline, taxane, and trastuzumab-based neoadjuvant chemotherapy has shown promising results 5.
- Locally advanced breast cancer (LABC), which includes advanced-stage primary tumors, cancers with extensive nodal involvement, and inflammatory breast carcinomas 3, 4, 6.
Treatment Outcomes and Response
The effectiveness of neoadjuvant chemotherapy can vary depending on the individual and the type of cancer.
- Pathologic complete response (pCR) is a significant predictor of excellent long-term outcomes, especially in patients with aggressive phenotype breast cancer 2, 5.
- Patients who achieve a pCR after neoadjuvant chemotherapy tend to have better disease-free survival (DFS) and overall survival (OS) rates 2, 5, 6.
- The response to neoadjuvant chemotherapy can inform treatment decisions and may influence the choice of subsequent therapies 6.