Can Early Response Assessment Guide Neoadjuvant Chemotherapy in Early-Stage Breast Cancer?

Randomized clinical trials conducted over the last three decades have shown that systemic adjuvant therapy reduces the risk of recurrence and death in patients with early-stage breast cancer. In patients with locally advanced and inflammatory breast cancer, the use of chemotherapy before surgery (neoadjuvant or preoperative approach) is the standard of care. A clinical and/or radiological response is achieved in most patients, and this response facilitates optimal surgery and radiation therapy. The success of neoadjuvant chemotherapy for locally advanced breast cancer, combined with emerging data on the use of adjuvant chemotherapy, led to studies investigating neoadjuvant chemotherapy among women with operable breast cancer. Randomized clinical trials of adjuvant vs neoadjuvant chemotherapy in patients with early-stage operable breast cancer showed no difference in disease-free or overall survival rates. Potential advantages of the neoadjuvant approach include surgical downstaging among women who might otherwise have required a mastectomy, increasing rates of breast conservation, and in vivo testing of sensitivity of cancer cells to the systemic therapy used.