Adjuvant therapy after preoperative treatment for breast cancer

E Ciruelos

doi:10.1186/bcr2273

Abstract

The increase in the use of preoperative chemotherapy has raised new questions regarding how to optimize locoregional and systemic adjuvant treatment. When patients are given preoperative systemic therapy, the preferred therapeutic regimens are the same as those established as safe and active in the adjuvant setting. At present, no data suggest that systemic treatment should be tailored, in one direction or another, based on initial tumor response or lack thereof (except for frank disease progression while on treatment), or based on the extent of residual disease. Adjuvant locoregional and systemic treatment after preoperative chemotherapy for breast cancer is still controversial. No high-quality data from prospective trials are available; nevertheless, locoregional therapy decisions should be based on both pretreatment and the clinical extent of disease. Sentinel node biopsy can be performed before and after preoperative therapy in patients with clinical N0 disease at diagnosis. It is not clear whether resection margins should be differently evaluated after preoperative therapy than in the standard setting. The success of breast-conserving surgery depends on careful patient selection and on an adequate surgical technique that achieves negative margins. Adjuvant breast irradiation is indicated for all patients who undergo breast conservation; for patients treated with mastectomy, chest-wall and regional nodal radiation must be done in those who present with clinical stage III disease or who have histologically positive lymph nodes at diagnosis. Additional studies are needed to determine the value of postmastectomy irradiation in clinical stage II breast cancer, as well as to determine the convenience of adjuvant systemic therapy in patients who do not achieve a good pathological response with preoperative treatment. Multidisciplinary treatment teams are critical in order to improve therapeutic management of these patients.

Highlights

The authors previously compared the local tissue re- In order to maintain a blood supply to the nipple areolar complex, some arrangement, breast reduction, and latissimus dorsi flap reconstruction breast tissue must be left behind
The authors provide practical guidelines for repairing a partial mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome [1]
The combination of on-treatment Ki67 with standard clinical features has allowed the derivation of a Preoperative Endocrine Therapy Index, which identified a group of patients with a very low likelihood of relapse on endocrine treatment alone [2]

Summary

Introduction

The authors previously compared the local tissue re- In order to maintain a blood supply to the nipple areolar complex, some arrangement, breast reduction, and latissimus dorsi flap reconstruction breast tissue must be left behind. The administration of BVZ plus first-line chemotherapy (paclitaxel, docetaxel) in the treatment of advanced breast carcinoma has lead to better outcomes in terms of response rate and time to progression in previous published studies. Results A total of 119 patients in 20 Spanish centers were included in the trial, with the following basal characteristics: median age 51 years (27 to 79); postmenopausal status, 83 patients (69.7%); estrogen receptor-positive, 64 patients (66.7%); HER2-negative, HER2-positive, unknown, 92 patients (95.8%), two patients (2.1%), two patients (2.1%), respectively; prior adjuvant therapy, 92 patients (95.8%) – anthracycline-based, 63 patients (72.4%) and taxane-based, 38 patients (43.6%). The present study compared the effect of two sequences of AI use – steroidal (exemestane (E)) and nonsteroidal (anastrozole (A)) – on serological and pathological biomarkers, when given in the neoadjuvant setting to patients with locally advanced breast cancer

Methods

Results

Conclusion