Spotlight on neoadjuvant therapy for breast cancer.

Abstract

Historically, the use of neoadjuvant therapy was considered only for patients with locally advanced or inflammatory breast cancer. Increasingly, systemic therapy is being given prior to surgery in patients with operable and early-stage breast cancer. Clinical trials have demonstrated that the use of neoadjuvant systemic therapy is equivalent to adjuvant therapy in terms of overall survival, and it increases the likelihood of successful breast-conserving therapy. As a result, patients who, at the time of presentation, are identified as meeting the criteria for receipt of adjuvant chemotherapy are being considered for delivery of the chemotherapy in the neoadjuvant setting. In addition to reduction in the size of the primary tumor, patients receiving neoadjuvant chemotherapy are less likely to have positive axillary nodes and may be candidates for nodesparing surgery. The pathologic assessment of the surgical specimens after neoadjuvant therapy provides information on the residual cancer burden (RCB) which correlates with disease-free survival outcomes. Neoadjuvant systemic therapy is no longer limited to chemotherapy but can include targeted agents and endocrine therapies specific for biologic subtypes. The neoadjuvant approach requires a multidisciplinary team, and communication across the disciplines is key to achieving optimal outcomes. In this special issue of Annals of Surgical Oncology is a series of articles focusing on the assessment and management of breast cancer patients treated with systemic therapy in the neoadjuvant setting. In the first article, Drs. Haddad and Goetz present an overview of the changing landscape of neoadjuvant therapy for breast cancer. 1 They review what has been learned from landmark trials in the field and how the approach has changed with the availability of targeted agents. When the treatment is targeted to the specific biologic subtype, the likelihood of response to therapy is significantly increased. They provide an overview of the RCB index and the