Experimental basis and clinical reality of preoperative (neoadjuvant) chemotherapy in breast cancer.

Abstract

The survival gains after conventional postoperative adjuvant chemotherapy are far from ideal. Even at best, the 25% survival improvement compared to untreated surgical controls is seldom exceeded (Bonadonna et al. 1987; Nissen-Meyer et al. 1978; Lippmann and Chabner (1986). The absence of more effective drugs for breast cancer remains consistently the main problem. At the same time, it is being increasingly recognized that the scheduling and dosing of most chemotherapeutic agents have not yet been adequately tested, as the original design of the presently utilized regimens has been largely empirical. There is a possibility that research on new scheduling of old drugs may be surprisingly fruitful. Preoperative timing of chemotherapy, along with questions on the selection and dose intensity of the chemotherapeutic drugs, emerge as one of the most exciting aspects of breast cancer clinical research. There is no question that such a development, if proven correct, will result in very significant practical alterations of the orthodox management of breast cancer. Therefore, before its full implementation, rigorous testing in clinical trials will be required.KeywordsBreast CancerClin OncolPreoperative ChemotherapyNode Negative Breast CancerClinical RealityThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.