Neoadjuvant treatment with taxanes in breast cancer

Abstract

Today, primary breast cancer is considered a systemic disease with a locoregional component. Systemic treatment, therefore, represents a fundamental aspect of the medical management of patients suffering from this pandemic malignancy. As at least equal efficacy has been shown for pre- and postoperative administration of a variety of cytotoxic treatments, preoperative chemotherapy is widely accepted today as an option to reduce the extent of surgery, to obtain freedom from locoregional and distant disease, and to obtain early information on tumor responsiveness. Several phase III studies have shown a higher chance of reaching these goals if treatment includes docetaxel or paclitaxel. Both taxanes are now recommended for standard preoperative systemic treatment in many countries. They have been used as monotherapy, in combination, or in sequence with anthracyclines. However, the question of whether the sequential or the simultaneous administration of anthracyclines and taxanes is superior, remains unsolved. Moreover, the impact of treatment duration on efficacy, which is usually longer for sequential regimens, is unknown in the neoadjuvant setting. Improved prediction of response by early sonographic response evaluation, or even better by tissue markers determined on diagnostic core biopsy will help to improve the selection of optimal candidates for specific cytotoxic treatment, as well as to avoid ineffective treatment in patients with resistant tumors. © 2006 S. Karger GmbH.