Using neoadjuvant therapy for breast cancer in clinical practice: when and how?

Excerpt

The roles of neoadjuvant therapy both as a standard therapeutic approach and a research tool are very closely tied and have yielded insights into both breast cancer biology and new drug development [1, 2]. From a clinician’s standpoint, however, the key questions that arise revolve around the clinical advantages of neo-adjuvant therapy in terms of surgical outcomes, long-term recurrence/mortality and decision-making. At the current time, the main advantage of neoadjuvant therapy is to improve the odds of adequate surgical resection, particularly breast-conserving surgery [3, 4]. Beyond that, long-term outcomes or clinical decision-making do not appear to be affected by the sequence of systemic therapy in relation to definitive surgery. It is becoming clear that breast cancer is heterogeneous. Genomically defined subsets, which map to some extent with hormone and HER2 receptor subtypes, exhibit differential recurrence hazard reductions with systemic therapies—and this concept also applies to neoadjuvant therapy response as well [5]. But there is also clinical diversity, for example, contrasting rapid onset inflammatory cancer to a more indolent cancer that has been clinically present for several years. Therefore, current neoadjuvant treatment paradigms must incorporate the base of evidence from large scale clinical trials as well as the biological context of the disease. The reports contained in this special issue of Breast Cancer Research and Treatment highlight current trends and results that are shaping both patient care and research in this area. …