Neoadjuvant chemoimmunotherapy in locally advanced breast cancer: a new avenue to be explored.

Abstract

Prolonged neoadjuvant chemotherapy has shown favorable results in patients with LABC. Patients treated with six cycles showed more favorable results compared with patients receiving four or five cycles. The prolonged presence of the draining lymph nodes, in combination with the repeated tumor antigen release from the primary tumor, DC recruitment, and activation, which may be further stimulated by GM-CSF administration, may account for the observed increase in survival. Furthermore, factors inhibiting new vessel formation produced by the primary tumor may inhibit growth of micrometastases, thus enhancing the effects of chemotherapy. We hypothesized that these immunologic and biologic processes inherent to the primary tumor and its draining lymph nodes, and their prolonged presence during chemotherapy, may be responsible for the observed survival. To study these biologic and immunologic events in tissue samples and peripheral blood of patients with LABC, we initiated an international randomized clinical trial using LABC as a model for other locally advanced tumors.