Neoadjuvant systemic therapy for breast cancer.

Abstract

The role of neoadjuvant therapy in the management of breast cancer has evolved dramatically over the past few decades. Preoperative treatment has the potential to downstage tumours and improve breast conservation rates as well as reduce the morbidity of axillary surgery. Furthermore, the in vivo sensitivity of the primary tumour to systemic therapy may be assessed at the time of final pathology when treatment is administered before operation. Monitoring of treatment response provides important prognostic and predictive information, with a pathological complete response (pCR) being associated with improved oncological outcomes1. Adjuvant therapy may also be affected in patients with residual disease who do not attain a pCR2–4. Neoadjuvant therapy for breast cancer may involve chemotherapy or endocrine therapy. The focus of this review is neoadjuvant therapy for the primary tumour in the breast. Axillary management after neoadjuvant therapy has been discussed previously5–8 and is beyond the scope of this review.