Neoadjuvant chemotherapy for breast cancer: a role for short-term fasting?

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443 ISSN 1758-1923 10.2217/BMT.13.49 © 2013 Future Medicine Ltd Breast Cancer Manage. (2013) 2(6), 443–446 Breast cancer is the second leading cause of cancer death in women in the USA. An estimated 232,340 women will be diagnosed with breast cancer in 2013, with approximately 90% of women with breast cancer presenting with loco-regional disease [1]. Traditionally, most women undergo a definitive surgical procedure that allows for accurate staging followed by treatment plans consisting of systemic chemotherapy and radiation commensurate with staging and guideline recommendations. Systemic chemotherapy is critical to eradicate occult micrometastatic disease after surgery. Adjuvant chemotherapy regimens have gone through rigorous head-tohead comparison in the past three decades, with anthracycline–taxane combinations regarded as the most active chemotherapy regimens for HER2-negative breast cancer [2]. Neoadjuvant chemotherapy has been established as a reasonable alternative for adjuvant chemotherapy, since multiple large randomized clinical trials have demonstrated that neoadjuvant chemotherapy provides identical disease-free (DFS) and overall survival (OS) benefits as adjuvant chemotherapy administered with the same regimens [3,4]. Neoadjuvant chemotherapy has also been shown to increase the breast conservation rate and decrease the rate of complete axillary lymph node dissection. Often, neoadjuvant chemotherapy represents the only reasonable option for women who present with more locally advanced disease and desire breast conservation. More importantly, response to neoadjuvant chemotherapy portends a good prognosis. Women with breast cancer that achieves a pathological complete remission (pCR) are expected to have excellent DFS and OS [5]. Irrespective of the different definitions of pCR in various clinical trials, the absence of invasive disease in both the breast and lymph nodes provides the best overall outcome. Evaluation of tumor responses to neoadjuvant regimens in patients who have not previously been exposed to any other systemic therapies could offer an efficient testing strategy to different regimens or interventions. Unfortunately, up to 75% of women do not achieve pCR when they are treated with anthracycline–taxane-based neoadjuvant chemotherapy [5]. Among those with four to nine positive axillary lymph nodes