title: State of the art of neoadjuvant chemotherapy in breast cancer: rationale, results and recent developments.
abstract: Aims, results, advantages and possible disadvantages of preoperative chemotherapy (pCHT) for breast cancer are discussed in this review. Established chemotherapeutic regimens are described with respect to new drugs that are added to combinations now and in the future. Illustrating the potential of new components, trastuzumab and cytotoxic chemotherapy, were combined in neoadjuvant trials for the first time. This approach yielded impressing and unprecedented high pathological response rates. An overview regarding current neoadjuvant cytostatic and immunotherapy trials is given. Established prognostic factors like axillary lymph-nodal status are altered during pCHT, which causes the need for new prognostic markers. The consequences of these changes for clinical decision making are demonstrated. It seems possible that the advances of gene array and protein expression profile technologies will lead to improved prognostic and predictive statements. Tumor tissue can be analyzed before during and after treatment in this regard recent studies investigating the response to specific, chemotherapeutics in correlation to molecular markers are reviewed. These approaches might enable us to identify chemoresistance of specific tumors. Furthermore pCHT allows testing of chemosensitivity in vivo in an early stage, which might lead to a more individualized cancer therapy. We discuss radiotherapy after neoadjuvant therapy and the risk of local relapse after breast conserving surgery, which was made feasible by pCHT. It is shown how the evaluation of efficacy of new cancer drugs, using the neoadjuvant situation, can be done more rapidly than in the metastatic and adjuvant setting.
authors.affiliation: Department of Obstetrics and Gynecology, University of Würzburg, Würzburg, Germany. Arnd_Hoenig@hotmail.com
authors.forename: Arnd
authors.initials: A
authors.lastname: Honig
authors.forename: Lorenz
authors.initials: L
authors.lastname: Rieger
authors.forename: Marc
authors.initials: M
authors.lastname: Sutterlin
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Johannes
authors.initials: J
authors.lastname: Dietl
authors.forename: Erich-Franz
authors.initials: EF
authors.lastname: Solomayer
references.citation: Clin Breast Cancer. 2002 May;3 Suppl 1:39-44
references.pmid: 12057045
references.citation: Gynakol Geburtshilfliche Rundsch. 2004 Apr;44(2):92-101
references.pmid: 15073438
references.citation: Proc Natl Acad Sci U S A. 2001 Sep 11;98(19):10869-74
references.pmid: 11553815
references.citation: Breast Cancer Res Treat. 1999 Nov;58(2):151-6
references.pmid: 10674880
references.citation: Ann Surg. 1995 Nov;222(5):612-8
references.pmid: 7487207
references.citation: Clin Cancer Res. 1997 Apr;3(4):593-600
references.pmid: 9815725
references.citation: Cancer Res. 1979 Oct;39(10):3861-5
references.pmid: 476622
references.citation: Cancer Res. 1989 Apr 15;49(8):1996-2001
references.pmid: 2702641
references.citation: Arch Surg. 1989 Jan;124(1):21-5
references.pmid: 2910244
references.citation: Cancer. 2001 Sep 1;92(5):1080-4
references.pmid: 11571718
references.citation: Eur J Cancer. 2004 Nov;40(16):2432-8
references.pmid: 15519516
references.citation: Anticancer Res. 2000 Nov-Dec;20(6B):4373-7
references.pmid: 11205274
references.citation: Cancer J. 2001 Sep-Oct;7(5):413-20
references.pmid: 11693900
references.citation: Lancet. 2003 Aug 2;362(9381):362-9
references.pmid: 12907009
references.citation: Cancer Res. 2001 Mar 15;61(6):2505-12
references.pmid: 11289122
references.citation: Cancer Invest. 2004;22(2):248-56
references.pmid: 15199607
references.citation: J Clin Oncol. 2002 Jan 1;20(1):17-23
references.pmid: 11773149
references.citation: N Engl J Med. 1976 Feb 19;294(8):405-10
references.pmid: 1246307
references.citation: Endocr Relat Cancer. 2002 Sep;9(3):183-95
references.pmid: 12237246
references.citation: J Clin Oncol. 1999 Feb;17(2):460-9
references.pmid: 10080586
references.citation: Cancer Res. 2001 Mar 1;61(5):2207-11
references.pmid: 11280788
references.citation: J Clin Oncol. 1999 Oct;17(10):3058-63
references.pmid: 10506600
references.citation: Ann Oncol. 2004 Sep;15(9):1352-7
references.pmid: 15319241
references.citation: Clin Breast Cancer. 2002 Oct;3(4):276-80
references.pmid: 12425756
references.citation: J Clin Oncol. 2005 Apr 20;23(12):2694-702
references.pmid: 15837984
references.citation: Anticancer Drugs. 2004 Feb;15(2):127-35
references.pmid: 15075668
references.citation: J Clin Oncol. 1997 Jul;15(7):2483-93
references.pmid: 9215816
references.citation: Nature. 2002 Jan 31;415(6871):530-6
references.pmid: 11823860
references.citation: Am J Clin Oncol. 2002 Jun;25(3):303-7
references.pmid: 12040294
references.citation: J Clin Oncol. 2001 Nov 15;19(22):4224-37
references.pmid: 11709566
references.citation: J Clin Oncol. 2002 Mar 15;20(6):1456-66
references.pmid: 11896092
references.citation: Cancer. 2002 Jun 15;94(12):3107-14
references.pmid: 12115341
references.citation: Cancer. 2004 Jul 15;101(2):258-63
references.pmid: 15241821
references.citation: Am Surg. 2004 Jul;70(7):565-9
references.pmid: 15279176
references.citation: Strahlenther Onkol. 2003 May;179(5):306-11
references.pmid: 12740657
references.citation: Ann Surg Oncol. 2002 Apr;9(3):243-7
references.pmid: 11923130
references.citation: Asian J Surg. 2004 Oct;27(4):262-7
references.pmid: 15564176
references.citation: Br J Cancer. 2002 Apr 8;86(7):1041-6
references.pmid: 11953845
references.citation: J Clin Oncol. 1998 Jan;16(1):107-14
references.pmid: 9440730
references.citation: Rays. 1997 Jul-Sep;22(3):417-24
references.pmid: 9446946
references.citation: Ann Surg. 2002 Sep;236(3):295-302; discussion 302-3
references.pmid: 12192316
references.citation: Nature. 2000 Aug 17;406(6797):747-52
references.pmid: 10963602
references.citation: Cancer. 2004 May 1;100(9):1814-22
references.pmid: 15112261
references.citation: J Clin Oncol. 2003 Jul 1;21(13):2600-8
references.pmid: 12829681
references.citation: Acta Oncol. 1999;38(5):597-601
references.pmid: 10427948
references.citation: Breast. 2003 Dec;12(6):538-42
references.pmid: 14659132
references.citation: Eur J Cancer. 2002 Nov;38(17):2214-21
references.pmid: 12441257
references.citation: Br J Cancer. 1999 Aug;80(12):1968-73
references.pmid: 10471047
references.citation: J Clin Oncol. 1998 Aug;16(8):2672-85
references.pmid: 9704717
references.citation: Clin Cancer Res. 2000 Dec;6(12):4610-7
references.pmid: 11156210
references.citation: Oncology (Williston Park). 2002 Jul;16(7):871-84, 889; discussion 889-90, 892-4, 897-8
references.pmid: 12164555
references.citation: Clin Breast Cancer. 2002 Oct;3 Suppl 2:S69-74
references.pmid: 12435290
references.citation: Am J Clin Oncol. 2002 Apr;25(2):172-7
references.pmid: 11943897
references.citation: Int J Cancer. 1998 Aug 21;79(4):376-83
references.pmid: 9699530
references.citation: Ann Oncol. 2005 Jan;16(1):56-63
references.pmid: 15598939
references.citation: J Clin Oncol. 2004 Jun 15;22(12):2303-12
references.pmid: 15197191
references.citation: Hum Mutat. 2003 Mar;21(3):292-300
references.pmid: 12619115
references.citation: Breast Cancer. 2002;9(1):8-14
references.pmid: 12196715
references.citation: J Clin Oncol. 1995 Mar;13(3):537-40
references.pmid: 7884412
references.citation: Br J Cancer. 1990 Jun;61(6):877-80
references.pmid: 2372489
references.citation: Bull Cancer. 2002 Aug;89 Spec No:S107-14
references.pmid: 12449040
references.citation: J Surg Oncol. 2002 May;80(1):4-11
references.pmid: 11967899
references.citation: Cancer Res. 1989 Apr 15;49(8):2002-4
references.pmid: 2522814
references.citation: J Clin Oncol. 2004 Jun 15;22(12):2294-302
references.pmid: 15197190
references.citation: World J Surg. 2004 Oct;28(10):1019-24
references.pmid: 15573258
references.citation: J Clin Oncol. 2001 Sep 15;19(18):3828-35
references.pmid: 11559720
references.citation: Hum Pathol. 2004 Jul;35(7):781-4
references.pmid: 15257539
references.citation: Int J Radiat Oncol Biol Phys. 2002 Jul 15;53(4):880-8
references.pmid: 12095553
references.citation: Endocr Relat Cancer. 2003 Mar;10(1):91-8
references.pmid: 12653672
references.citation: Oncologist. 2002;7(3):239-45
references.pmid: 12065797
references.citation: Anticancer Res. 1996 Sep-Oct;16(5B):3105-10
references.pmid: 8920776
references.citation: Crit Rev Oncol Hematol. 2003 Jan;45(1):77-90
references.pmid: 12482573
references.citation: Clin Breast Cancer. 2004 Aug;5(3):198-207
references.pmid: 15335452
references.citation: J Clin Oncol. 1998 Apr;16(4):1633-5
references.pmid: 9552079
references.citation: Ann Surg Oncol. 2004 Sep;11(9):854-60
references.pmid: 15313733
references.citation: J Clin Oncol. 2003 Nov 15;21(22):4165-74
references.pmid: 14559892
references.citation: Lancet. 1998 May 16;351(9114):1451-67
references.pmid: 9605801
references.citation: J Clin Oncol. 2005 Mar 10;23(8):1760-75
references.pmid: 15755984
references.citation: Int J Cancer. 2000 Jan 20;89(1):32-8
references.pmid: 10719728
references.citation: Am J Surg. 1998 Dec;176(6):502-9
references.pmid: 9926779
references.citation: J Natl Cancer Inst Monogr. 2001;(30):96-102
references.pmid: 11773300
references.citation: Br J Cancer. 2003 Feb 10;88(3):406-12
references.pmid: 12569384
references.citation: J Clin Oncol. 2002 Jun 15;20(12):2812-23
references.pmid: 12065558
references.citation: Eur J Cancer. 1995 Nov;31A(12):1969-75
references.pmid: 8562150
references.citation: N Engl J Med. 2002 Dec 19;347(25):1999-2009
references.pmid: 12490681
references.citation: Cancer Res. 1983 Apr;43(4):1488-92
references.pmid: 6831397
references.citation: Cancer. 1979 Feb;43(2):451-8
references.pmid: 421172
references.citation: Ann Oncol. 1999 Jan;10(1):47-52
references.pmid: 10076721
references.citation: J Cancer Res Clin Oncol. 2004 May;130(5):273-8
references.pmid: 14986112
references.citation: Eur J Cancer. 2004 Feb;40(3):342-51
references.pmid: 14746851
references.citation: Am J Surg. 2001 Oct;182(4):407-10
references.pmid: 11720681
references.citation: Lancet. 1998 Sep 19;352(9132):930-42
references.pmid: 9752815