Indications For Neoadjuvant Treatment Research Articles

Neoadjuvant treatment of colorectal cancer: comprehensive review.

Neoadjuvant therapy has an established role in the treatment of patients with colorectal cancer. However, its role continues to evolve due to both advances in the available treatment modalities, and refinements in the indications for neoadjuvant treatment and subsequent surgery. A narrative review of the most recent relevant literature was conducted. Short-course radiotherapy and long-course chemoradiotherapy have an established role in improving local but not systemic disease control in patients with rectal cancer. Total neoadjuvant therapy offers advantages over short-course radiotherapy and long-course chemoradiotherapy, not only in terms of increased local response but also in reducing the risk of systemic relapses. Non-operative management is increasingly preferred to surgery in patients with rectal cancer and clinical complete responses but is still associated with some negative impacts on functional outcomes. Neoadjuvant chemotherapy may be of some benefit in patients with locally advanced colon cancer with proficient mismatch repair, although patient selection is a major challenge. Neoadjuvant immunotherapy in patients with deficient mismatch repair cancers in the colon or rectum is altering the treatment paradigm for these patients. Neoadjuvant treatments for patients with colon or rectal cancers continue to evolve, increasing the complexity of decision-making for patients and clinicians alike. This review describes the current guidance and most recent developments.

Lateral Lymph Node Dissection for Locally Advanced Rectal Carcinoma: A Step-by-Step Description of Surgical Anatomical Planes During Cadaveric Dissection and Minimally Invasive Surgery.

Total mesorectal excision (TME) is accepted as gold standard method in rectal cancer globally. But there is no standard for lateral lymph nodes. Combination of neoadjuvant treatment plus lateral lymph node dissection (LLND) in select patients might be a promising method. Our purpose is to describe the anatomic landmarks of LLND on cadavers and minimally invasive surgery. Local advanced rectal cancer and lateral lymph node (LLN) metastasis are accepted as an indication of neoadjuvant treatment. LLND was performed according to preoperative imaging after radiochemotherapy. Twenty-eight (10.5%) of 267 patients with rectal cancer who had suspected lateral lymph node metastasis (LLNM) with magnetic resonance imaging (MRI) underwent LLND in addition to TME after neoadjuvant chemoradiotherapy. Eight of them had LLNM. Three patients had bilateral LLND and only 1 had LLNM. The median number of harvested lymph nodes was 6. The rates of LLNM increased with the presence of poor prognosis markers. One regional and 1 distant recurrence were detected in patients who had no LLN metastasis compared with2 regional and 4 distant recurrences in the LLN-positive group. Local advanced rectal cancer cases may benefit from LLND, but it does not appear to have an effect on overall survival. There is no consensus whether size and/or morphologic criteria in MRI are the ideal guide for LLND.

80 Has the global pandemic health and social situation affected the management of obstructive jaundice secondary to tumuor pathology? A review of our experience in two years of the pandemic

Abstract Objectives SARS-CoV-2(COVID19) infection forced a redistribution of hospital resources, including reduction and delay of scheduled surgical activity. We analysed the management of obstructive jaundice (OJ) in patients with potentially resectable periampullary pathology in a tertiary care centre during the pandemic. Methods Observational, single-centre, retrospective study, during the years 2020-2021. The main inclusion criterion was the indication for cephalic duodenopancreatectomy. Patients with criteria of unresectability or indication for neoadjuvant treatment were excluded. We analysed OJ drainage techniques (endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTCD) as well as associated complications. Indications for drainage were: bilirubin >10 mg/dl, cholangitis or expected surgery >2 weeks after inclusion on the waiting list. Results We analysed 75 patients (53.3% male) with an age range of 28-80 years. 59% of patients required drainage by OJ, ERCP was performed in 23 cases and PTCD in 21 cases. Twenty-three stents were placed, 52.1% of which were metal-covered. The most frequent complications associated with ERCP (43.4%) were cholangitis and pancreatitis. The most frequent complication associated with PTCD (28.5%) was cholangitis. Conclusion The correct management of OJ secondary to resectable periampullary tumours is early surgery without preoperative drainage. In case drainage is necessary, the endoscopic approach with placement of a metallic stent seems to be the most indicated. In our series, the COVID19 pandemic led to more preoperative biliary drainage due to longer delays in surgical scheduling, as well as more PTCD approaches due to greater accessibility, this technique also being valid.

Abstract P2-12-12: The effect of Neoadjuvant Chemotherapy in reducing the need for axillary lymph node dissection in HR+/HER2- node positive breast cancers

Abstract Background In recent years, indications for neoadjuvant treatment (NAC) have been extended to patients with operable disease at diagnosis and it is increasingly being used in patients to reduce extent of axillary involvement and allow for more limited surgery in the breast and axilla. The increasing use of this therapy however has raised questions about optimal surgical exploration of the axilla post-chemotherapy. In this study therefore, we aimed to analyze the effect of NAC in reducing the need for axillary lymph node dissection (ALND), regardless of pathologic nodal status, in those who present with clinically node positive disease at diagnosis. Methods We sampled the National Cancer Database (NCDB) (2004-2016) for female patients with hormone receptor (HR) positive [estrogen receptor (ER) positive and/or progesterone receptor) (PR) positive], human epidermal growth factor receptor 2 (HER 2) negative, clinically node positive breast cancers. We then performed a multivariate logistic regression analysis to evaluate associations between chemotherapy regimen, disease, demographic, and geographic characteristics with the patients undergoing ALND. Statistics were performed using SPSS version 28.0 (190). Results N= 134704 female patients were included in the analysis; 79.2% Caucasian, mean age 59.13 years (SD = 13.95). Receiving NAC was associated with lower odds of undergoing ALND (OR = 0.849, 95% CI = 0.822 - 0.879, p <0.001) as compared to adjuvant chemotherapy (AC). On multivariate analysis, patients younger than 50 years old (ref, p = 0.005), black (OR = 0.824, 95% CI = 0.788 - 0.862, p <0.001), and uninsured (ref, p<0.001) were associated with lower odds of undergoing ALND as compared to their counterparts. In contrast, receiving care at Integrated Network Cancer Programs (OR = 1.182, 95% CI = 1.107 -1.261, p < 0.001) and residing in the Pacific region (OR = 1.519, 95% CI = 1.402 - 1.646, p < 0.001) was associated with a higher odds of patients undergoing ALND as compared to their counterparts. Conclusion Our findings indicate that for HR+/HER2-, node positive breast cancer, receiving chemotherapy in the neoadjuvant setting is associated with lower odds of ALND compared to when chemotherapy is received adjuvantly. Further studies exploring the effect of NAC on the nodal status post operatively, would help strengthen our findings. Additionally, while the use of chemotherapy remains a clinical decision, our study highlights that disparities in terms of sociodemographic and geographic factors may influence the receipt of such treatment in this cohort of patients. Citation Format: Iktej Singh Jabbal, Diana Saravia, Marita Yaghi, Nadeem Bilani, Leah Elson, Hong Liang, Zeina Nahleh. The effect of Neoadjuvant Chemotherapy in reducing the need for axillary lymph node dissection in HR+/HER2- node positive breast cancers [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-12-12.

Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

IntroductionPreoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. MethodThis is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. ResultsOut of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. ConclusionThere was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.

Abstract P2-16-04: National utilisation of neoadjuvant systemic therapy and impact on surgical treatment - A prospective multi-centre cohort study

Abstract Introduction: Potential advantages of neoadjuvant systemic therapy (NST) include downstaging disease to minimise surgery, and in vivo assessment of tumour sensitivity to therapeutic drugs. Considerable variation in NST use remains, however, and it is unclear whether pathological response rates reflect those reported in trials, or whether downstaging achieved impacts on surgical decision-making. The NeST prospective multicentre study will address these questions through investigating patterns of care in the UK. Methods: Women undergoing NST as their primary breast cancer treatment (chemotherapy (CT), endocrine (ET) and targeted therapies) in UK centres between December 2017 and November 2018 were included. Anonymised data was collected at 37 participating centres, and uploaded to REDCap. Results: 1179 patients received neoadjuvant treatment during the study period. 41% had HER2+ disease, 28% TNBC and 31% ER+ HER2- disease. 48% were node positive and 52% node negative. Cited indications for neoadjuvant treatment were (more than one option applicable to each patient): Downstaging (mastectomy to breast conservation) 37% Facilitate dual antiHER2 therapy 33% Inoperable disease 19% Improved cosmesis (reduced volume of excision) 17% Facilitate BRCA testing 9% Inflammatory breast cancer 6% In patients recommended to receive NST, the MDT decision was for neoadjuvant CT in 87% of cases and neoadjuvant ET in 13%. For ER+ disease, the commonest reasons for prescribing CT were high grade disease and pre-menopausal status. The majority were treated with anthracycline-taxane combinations. 21% of TNBC patients were treated with platinum-containing regimens. In HER2+ disease, 54% were treated with dual antiHER2 therapies/chemotherapy, with 10% receiving chemotherapy/single antiHER2 agent (trastuzumab). Centres were asked to indicate primary breast surgical treatment recommended prior to/without NST. At abstract submission, this data was available for 887 patients. 31 had inoperable disease. A total of 477 were considered to require mastectomy, with disease not amenable to breast conservation surgery (BCS). A further 379 patients were considered candidates for BCS. Data on final surgical procedure was available for 765 patients. Of those patients determined suitable only for mastectomy at diagnosis, 123 underwent BCS as their primary operation - a downstaging rate of 26%. The overall mastectomy rate in this cohort was 48%, with 33% having mastectomy and 15% mastectomy with immediate reconstruction. Pathological response data was available in 672 patients, with an overall pathological complete response (pCR) rate of 29% (defined as no residual invasive or in situ disease). pCR rate according to molecular subtype was 37% for HER2+ disease, 35% for TNBC and 7% for ER+, HER2-ve disease. The pCR rate in patients downstaged from mastectomy to BCS was 27%. Conclusions: This UK national prospective study suggests that surgical downstaging remains a key indication for the use of NST. This is reflected in the fact that 26% of patients in this series were downstaged from an original surgical plan for mastectomy, with NST enabling BCS in these patients. However, based on this data it appears that surgical downstaging is no more likely in those with pCR compared to those without a pCR. Additional indications for NST are emerging, according to disease biology. There is widespread use of dual antiHER2 targeted therapies in this setting, with increasing use of platinum-containing regimens for TNBC. Neoadjuvant CT continues to be frequently used in the treatment of ER+ disease, despite known low pCR rates in this context, which are again confirmed. Low rates of neoadjuvant ET use are reported. Data collection is ongoing; updated data will be presented in December 2019. Citation Format: Stuart A McIntosh, Gareth W Irwin, Finian Bannon, Charlotte Coles, Ellen Copson, Ramsey Cutress, Rajiv Dave, Margaret Grayson, Chris Holcombe, Sheeba Irshad, Ciara O'Brien, Rachel O'Connell, Carlo Palmieri, Abeer M Shaaban, Nisha Sharma, Jagdeep Singh, Ian Whitehead, Shelley Potter. National utilisation of neoadjuvant systemic therapy and impact on surgical treatment - A prospective multi-centre cohort study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-04.

Ocular preservation with neoadjuvant vismodegib in patients with locally advanced periocular basal cell carcinoma

Locally advanced (T4 perAmerican Joint Committee on Cancer (AJCC) 8th edition) periocular basal cell carcinoma (BCC) can lead to loss of the eye. We report the neoadjuvant use of vismodegib followed by surgery in patients with such lesions with eye preservation as primary goal. This retrospective interventional study includes all patients with a T4 periocular BCC (per 8th edition AJCC for eyelid carcinoma) treated by the senior author between 2013and2017 with neoadjuvant vismodegib prior to definitive surgery. Eight patients had a T4 tumour. Six patients presented with recurrent disease. Indications for neoadjuvant treatment were an unresectable tumour in onepatient, an attempt to avoid an orbital exenteration in sixpatients and an attempt to avoid disfiguring facial surgery in onepatient. Patients were treated for a median of 14 months (range: 4-36 months). All patients underwent an eye-sparing surgery following neoadjuvant vismodegib and all final surgical margins were negative for tumour. Five patients had a complete response to vismodegib with no microscopic residual BCC found during surgery; threepatients had a significant partial response with residual tumour found on pathology. At last follow-up, a mean of 18 (range:6-43) months after surgery, all patients were off-vismodegib and alive without evidence of disease. Neoadjuvant vismodegib for locally advanced (T4) periocular BCC enabled an eye-sparing surgery in all patients in our cohort. Prolonged treatment was welltolerated by most patients. Over half of patients achieved a complete response with no residual microscopic disease. Careful long-term follow-up is needed to confirm long-term disease-free survival.

Updates in version 2.2018 of the NCCN guidelines for gastric cancer

Updates in version 2.2018 of the NCCN guidelines for gastric cancer

Liver surgery for metastatic colorectal cancer: the surgical oncologist perspective

Neoadjuvant/conversion chemotherapy has emerged as an indispensable tool to achieve resectability of initially unresectable metastatic colorectal cancer and improves oncological outcomes. In parallel, surgical strategy has adopted a more aggressive treatment approach to achieve complete tumor clearance. However, chemotherapy affects liver function and combined with extensive liver resection, morbidity has increased, thereby compromising oncological outcome. There is an imperative need for careful patient selection to optimize patient management. In this review, we discuss available evidence and indications for neoadjuvant treatment in the management of colorectal cancer liver metastases, on preoperative patient selection and identification of high-risk patients, potential treatment strategies to promote postoperative liver regeneration to avoid postoperative morbidity and potentially deleterious side effects of these therapies on tumor growth.

Emlődaganatos betegek primer szisztémás terápiája során elért eredményeink (2007–2010)

The importance of preoperative neoadjuvant (NA) systemic treatment in operable breast cancer has significantly increased in the last few years. The aim of our retrospective study was to determine the effect of NA therapy in breast cancer patients treated in our unit and analyze radiological and pathological response rates in the context of surgical treatment. One hundred and fourteen cases of breast cancer with NA therapy were analyzed and clinical data were collected from March 2007 to December 2010. Twenty-two patients received NA treatment for inoperable tumours. As far as operable cancers (92 patients), the indications for NA treatment were high tumour grade, presence of axillary metastasis and relatively young age. 5-Fluorouracil-Epirubicin-Cyclophosphamid or Taxotere-Epirubicin regimens were administered in 6 cycles followed by radiological evaluation and surgery. Herein, we compared the preoperative staging with the pathological results after surgery. NA therapy resulted in complete regression in 17% of patients, significant regression in 21%, while moderate regression was achieved in 43% of patients. No regression was detected in 19%. The decrease in T stage was not followed by decrease in N stage in significant number of cases. Moreover, in some cases NA therapy caused complete radiological regression, while histologically it still remained positive. In certain cases, breast conserving surgery was feasible due to down-staging caused by NA therapy. NA therapy was effective primarily in decreasing tumour size; however, it was less effective on axillary lymph node metastases. Due to the presence of the residual DCIS component, the volume of resection could not be decreased as much as down-staging of the invasive cancer would have permitted.

Neoadjuvant chemoradiotherapy for locally advanced pancreas cancer does not lead to tumor regression

Introduction Neo-adjuvant chemo-radiotherapy is proposed to improve resectability of locally-advanced/borderline-resectable pancreas cancer (LAPC). The ability of neo-adjuvant therapy to provide tumor regression has not been reported. Methods We reviewed pre and post treatment CT scans of patients undergoing neo-adjuvant chemo-radiotherapy (cisplatin, interferon-alpha, 5-FU, radiation) in a phase II clinical trial for LAPC between 2005 and 2008. Response to therapy was assessed. Results 15 patients (median age 61years, males 66%) received neo-adjuvant therapy for LAPC during 2005-08. Mean tumor size was 3.9cm. Indications for neo-adjuvant treatment included one or more of the following: Involvement of superior mesenteric artery (SMA) (≤180deg-3 patients, >180deg-1 patient), celiac axis (≤180deg-2 patients, >180deg-3 patients), hepatic artery (HA) (>180deg-6 patients), and/or superior mesenteric vein/portal vein (SMV/PV) (≤180deg-6 patients, >180deg-7 patients). 4 of 9 (44.4%) patients with borderline resectable disease (tumor involving ≤ 180deg circumference of the SMA, short-segment encasement/abutment of the common HA, or short-segment occlusion of SMV/PV) were resected after neo-adjuvant therapy. Regression of major vascular involvement was not observed in any patients. No patient with >180deg arterial involvement had tumor regression or resection. Five patients (33%) had disease progression during neo-adjuvant therapy. Pre-treatment and post-treatment tumor density (Hounsfield units) was similar (Pre-treatment HU: 60.4±6.48, post-treatment HU: 62.2±6.5, p=0.369). Conclusions Neo-adjuvant treatment does not provide tumor regression of LAPC with major vascular involvement. Patient selection for neo-adjuvant trial enrollment should remain focused on borderline disease which may have potential for surgical resection.

Preoperative Rectal Cancer Management: Wide International Practice Makes Outcome Comparison Challenging: Reply

In a letter to the editor Dr. Hottenrott provides valuable comments [1] on our survey describing international preoperative rectal cancer management [2]. In our opinion, three key messages are derived from our survey: First, most surgeons agree to neoadjuvant treatment when there is an increased risk of finding histologically positive circumferential margins. In addition, we found more than 40 other indications for neoadjuvant treatment (see our Table 4). This emphasizes the need for an international agreement, as different indications for neoadjuvant treatment will select noncomparable groups of patients in outcome studies. Second, we have shown (see our Table 6) that multidisciplinary team (MDT) meetings significantly influence several important decisions in preoperative rectal cancer management. Interestingly, centers with regular MDT have a higher rate of using magnetic resonance imaging (MRI) (Odds Ratio [OR] = 3.62) and consider a threatened circumferential resection margin (CRM) as indication for neoadjuvant treatment (OR = 5.67). We believe that MDT improves preoperative management of rectal cancer by increasing adherence to national guidelines. Similar discussions in international rectal cancer societies are needed aiming towards an international consensus statement. Finally, our survey revealed sparse use (35% of all cases) of MRI. The goal for the radiologic examination in rectal cancer is to explore the tumor’s relation to nearby anatomical structures. This evaluation will conclude with TNM staging, important for chemoradiotheraphy, surgical treatment, and prognosis. Magnetic resonance imaging has a central role in this evaluation and should be the first choice radiologic modality [3]. Not only is MRI crucial in detection of TNM stage but also plays a central role in determination of the tumor’s distance to the mesorectal fascia and the CRM. Magnetic resonance imaging has moderate sensitivity on T1 and T2 tumors, and should be supplemented with rectal ultrasound. In our survey, 18F-fluorodeoxyglucose positron emission tomography (PET) was used by 55% in selected cases and by 1% in all cases. In our opinion PET has no central role in primary management of rectal cancer [4]; however, we believe PET will gain increased importance in management of rectal cancer in the future. Biologically targeted agents for adjuvant and neoadjuvant treatment are promising treatment options; however, patient selection and prediction of treatment effects remain problematic [5]. The wide variations in practice for preoperative management of rectal cancer should alert national and international rectal cancer experts as well as health care administrators. This will influence health care costs, side effects, quality of life, local recurrence, and cancer-specific survival.

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

BackgroundLittle is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates.MethodsOne hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer.ResultsOne hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years’ experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81).ConclusionsThere was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

Magnetic resonance imaging (MRI)-based indication for neoadjuvant treatment of rectal carcinoma and the surrogate endpoint CRM status

Is it possible to reduce the frequency of neoadjuvant therapy for rectal carcinoma and nevertheless achieve a rate of more than 90% circumferential resection margin (CRM)-negative resection specimens by a novel concept of magnetic resonance imaging (MRI)-based therapy planning? One hundred eighty-one patients from Berlin and Mainz, Germany, with primary rectal carcinoma, without distant metastasis, underwent radical surgery with curative intention. Surgical procedures applied were anterior resection with total mesorectal excision (TME) or partial mesorectal excision (PME; PME for tumours of the upper rectum) or abdominoperineal excision with TME. With MRI selection of the highest-risk cases, neoadjuvant therapy was given to only 62 of 181 (34.3%). The rate of CRM-negative resection specimens on histology was 170 of 181 (93.9%) for all patients, and in Berlin, only 1 of 93 (1%) specimens was CRM-positive. Patients selected for primary surgery had CRM-negative specimens on histology in 114 of 119 (95.8%). Those selected for neoadjuvant therapy had a lower rate of clear margin: 56 of 62 (90%). By applying a MRI-based indication, the frequency of neoadjuvant treatment with its acute and late adverse effects can be reduced to 30-35% without reduction of pathologically CRM-negative resection specimens and, thus, without the danger of worsening the oncological long-term results. This concept should be confirmed in prospective multicentre observation studies with quality assurance of MRI, surgery and pathology.

Recommendations From an International Expert Panel on the Use of Neoadjuvant (Primary) Systemic Treatment of Operable Breast Cancer: An Update

Neoadjuvant (primary systemic) treatment is the standard treatment for locally advanced breast cancer and a standard option for primary operable disease. Because of new treatments and new understandings of breast cancer, however, recommendations published in 2003 regarding neoadjuvant treatment for operable disease required updating. Therefore, a second international panel of representatives of a number of breast cancer clinical research groups was convened in September 2004 to update these recommendations. As part of this effort, data published to date were reviewed critically and indications for neoadjuvant treatment were newly defined.