Neo-adjuvant therapy in breast cancer

Abstract

In summary, the available data to date suggest a significant and important correlation between pCR after neo-adjuvant therapy and disease-free survival as well as overall survival. Moreover, NAC increases the rate of breast-conserving surgeries (in at least some studies) and is associated with fewer positive axillary lymph nodes at the time of surgery. The preoperative addition of a taxane to preoperative AC results in a significant increase in the rate of CCR, pCR and negative axillary nodes in patients with operable breast cancer, and in at least one published study, is associated with a 3-year survival advantage over standard anthracycline-based combination chemotherapy. Synergic, non-anthracycline, trastuzumab-based regimens seem to be an important advance for treatment of the HER2-overexpressing breast cancer population. Other synergic, non-anthracycline trastuzumab-containing regimens, such as vinorelbine plus trastuzumab, are also currently being explored. Finally, the presurgical, neo-adjuvant setting constitutes a special clinical translational opportunity in the field of breast cancer research for in vivo evaluation of molecularly targeted experimental therapeutics, because paired pretreatment diagnostic biopsy samples and posttreatment lumpectomy samples are available for correlative scientific laboratory studies of molecular targets and evaluation of pharmacodynamic end points. The use of intermediate clinical end points such as pCR then allows for relatively rapid assessment of clinical efficacy. Consequently, presurgical clinical trial study designs for evaluation of the growing list of novel targeted agents approaches should be exploited for the treatment of early breast cancer. © 2005 European Society for Medical Oncology.