title: Current and future role of neoadjuvant therapy for breast cancer.
abstract: Neoadjuvant systemic chemotherapy is a possible therapeutic approach for the treatment of locally advanced operable, primarily non-operable or inflammatory breast cancer. Neoadjuvant systemic chemotherapy is an option for breast cancer patients who would require adjuvant chemotherapy otherwise based on clinical and histological examination and imaging. The use of neoadjuvant systemic therapy in operable breast cancer is currently increasing because of its advantages that include higher rates of breast conserving surgery and the possibility of measuring early in-vivo response to systemic treatment. The timing of axillary sentinel lymph node diagnosis (i.e. before or after neoadjuvant chemotherapy) is critical in that it may influence the likelihood of axillary preservation. It is not yet clear if neoadjuvant therapy might improve outcomes in certain subgroups of breast cancer patients. Neoadjuvant treatment modalities require a close collaboration between oncology professionals, including surgeons, gynecologists, medical oncologists, radiation oncologists, radiologists and pathologists. The most important parameter for treatment success and improved overall survival is the achievement of a pathologic complete response (pCR), although the role of pCR in patients with luminal A like tumours might be less informative. Identification of patient subgroups with high pCR rates may allow less invasive surgical or radiological interventions. Patients not achieving a pCR may be candidates for postoperative clinical trials exploring novel systemic treatments.
authors.affiliation: Department of Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany. Electronic address: michael.untch@helios-kliniken.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Gottfried E
authors.initials: GE
authors.lastname: Konecny
authors.affiliation: Interdisciplinary Breast Center, Ob/Gyn, Technische Universitaet Muenchen, Klinikum rechts der Isar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Paepke
authors.affiliation: German Breast Group c/o GBG Forschungs GmbH, Neu Isenburg, Germany; University Women's Hospital, Frankfurt, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: von Minckwitz
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Breast conserving surgery; Molecular subtypes; Neoadjuvant systemic therapy; Pathologic complete response