The neoadjuvant approach in breast cancer treatment: it is not just about chemotherapy anymore.

Abstract

Although the use of neoadjuvant chemotherapy (NCT) in breast cancer was once reserved for patients with locally advanced disease or inflammatory breast cancers, it is increasingly used in patients with early-stage tumors. This review outlines the pertinent research in the field over the last year and discusses the clinical implications. The present review will focus on three evolving areas in the neoadjuvant research field: factors determining response, use of endocrine and biologic therapies, and how to manage patients following response. NCT in breast cancer is a remarkable research platform providing insight into tumor biology and treatment efficacy in an expedited timeframe. Refining patient selection based on tumor and patient characteristics allows clinicians to limit potentially toxic therapy to those patients expected to receive the greatest benefit. Additionally, exploring new agents and sequencing of regimens based on these characteristics has great potential for impacting local-regional and systemic outcomes. Lastly, as the population of patients undergoing NCT grows, we must constantly adjust our treatment paradigms. We need to monitor them carefully and accurately, understand the implication of a treated tumor for future therapy, and determine how much additional therapy is necessary.