Neoadjuvant Therapies

  • Max S. Mano
  • Rudinei Diogo Marques Linck


Neoadjuvant therapy consists of the preoperative administration of systemic treatment in patients with nonmetastatic breast cancer (BC). The term neoadjuvant chemotherapy (neoChT) does not adequately reflect the wide range of possibilities for systemic treatment that can be employed in this setting—such as endocrine therapy and new target therapies—being “technically more appropriate” to use neoadjuvant systemic therapy (NST); see Table 1.

Recommended Reading

  1. 1.
    Buzdar AU, Valero V, Ibrahim NK, et al. Neoadjuvant therapy with paclitaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide chemotherapy and concurrent trastuzumab in human epidermal growth factor receptor 2-positive operable breast cancer: an update of the initial randomized study population and data of additional patients treated with the same regimen. Clin Cancer Res. 2007;13(1):228–33. A small randomized institutional study showing that the addition of trastuzumab to neoChT elevates pCR to the expressive rate of 60%. Although trastuzumab was administered concomitantly throughout ChT (including anthracycline), there was no apparent increase in cardiotoxicity. CrossRefGoogle Scholar
  2. 2.
    Eiermann W, Paepke S, Appfelstaedt J, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study. Ann Oncol. 2001;12(11):1527–32. A randomized study that established the advantage of the letrozole aromatase inhibitor versus tamoxifen when administered for 4 months as neoET for menopausal patients with CM ER +. The gains were seen in terms of response rate and conservative breast surgery. CrossRefGoogle Scholar
  3. 3.
    Mauri D, Pavlidis N, Ioannidis JP, et al. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–94. A meta-analysis of nine studies comparing neoChT with adjuvant ChT, showing no impact on the prognosis. At the same time, it demonstrated the negative impact of the omission of definitive surgery on the rate of local recurrence. CrossRefGoogle Scholar
  4. 4.
    Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778–85. Mature joint analysis of NSABP studies B18 and B27. In the first one, there was no improvement in the prognosis with neoChT in relation to adjuvant ChT in the general study population, but a strong trend in the population under 50 years. In study B27, the addition of docetaxel doubled pCR, but did not impact conservative breast surgery rate or prognosis. CrossRefGoogle Scholar
  5. 5.
    von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796–804. Analysis of seven studies (n = 6.377) from the German Breast Group (GBG) showing the excellent correlation between pCR and prognosis in ER-, pure Her2 and luminal B tumors; however, a low correlation in luminal A and “triple–positive”. CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Max S. Mano
    • 1
  • Rudinei Diogo Marques Linck
    • 1
  1. 1.Clinical OncologySírio-Libanês HospitalSão PauloBrazil

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