Abstract
SummaryPreoperative administration of chemotherapy is a widespread treatment approach in early stage breast cancer whenever chemotherapy is indicated in principle. In addition, neoadjuvant treatment is today regarded as the preferred way of delivering systemic therapy in triple-negative and HER2-positive breast cancer. While preoperative chemotherapy allows for disease downstaging and increases breast conservation rates, achieving pathologic complete remission (pCR) is usually regarded as the most pertinent aim as pCR predicts for improved long-term outcome in high-risk breast cancer subtypes. A multitude of clinical trials therefore have focused on strategies to increase pCR rates. This short review summarizes outcomes of selected studies investigating the addition of further chemotherapeutic drugs or biologically targeted agents to standard regimens and provides an overview of novel strategies currently under clinical evaluation.
Highlights
The concept of preoperative chemotherapy was introduced nearly half a century ago in the treatment of patients with locally advanced, inoperable breast cancer [1]; this role changed over the following decadesA
Preoperative chemotherapy allows for disease downstaging and increases breast conservation rates; pathologic complete remission, is today regarded as the most pertinent endpoint [4]
In triple-negative breast cancer (TNBC), the disease-free survival (DFS) benefit in the nab-paclitaxel group was within the range predicted from the observed pathologic complete remission (pCR) difference; in luminal breast cancer, a residual effect of better chemotherapy beyond pCR must be assumed as the pCR delta was smaller in this patient subset
Summary
The concept of preoperative chemotherapy was introduced nearly half a century ago in the treatment of patients with locally advanced, inoperable breast cancer [1]; this role changed over the following decades. A positive correlation of pCR with overall survival (OS) was reported as well This observation eventually led to a multitude of studies aiming at increasing pCR rates by adding further chemotherapeutic agents, introducing new drugs instead of older ones, or adding biologically targeted agents such as antibodies or small molecules to standard treatment. In this context, the definition of pCR is relevant and today, pCR usually refers to a complete remission of invasive disease (with or without presence of ductal carcinoma in situ) in breast and axilla as this definition discriminates best between patients with favourable and unfavourable prognosis [6]
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