Primary systemic therapy in patients with breast cancer: rationale of use and magnitude of evidence

Abstract

Primary systemic therapy (PST) is considered part of multimodality therapy for locally advanced breast cancer. More recently, it has also been proposed for the treatment of operable disease. Although no randomized clinical trials have shown a clear survival benefit in comparison with postoperative treatment of early stage disease, several advantages may be depicted with the use of PST. This review focuses on the different considerations that have lead to the rising interest in the use of PST in patients with operable breast cancer and reports new advances on this subject. One of the most investigated topics in the treatment of breast cancer concerns the timing of chemotherapy in relation to surgery. Although postoperative (adjuvant) administration of systemic therapy is still the favorite option in the majority of patients with early stage disease, PST (also called neo-adjuvant, preoperative, induction) is increasingly proposed as a valuable alternative. On the contrary, PST is considered part of the standard care for patients with locally advanced breast cancer. This review focuses on the different considerations regarding the use of PST in patients with operable breast cancer reporting, also, new advances on this subject.