Breast Cancer pp 213-226 | Cite as

Primary Chemotherapy

  • Deborah L. Toppmeyer
Part of the Current Clinical Oncology book series (CCO)


Primary chemotherapy of breast cancer refers to the use of chemotherapy before definitive local treatment. Other synonymous terms include preoperative chemotherapy, neoadjuvant chemotherapy, induction chemotherapy, and upfront chemotherapy. Beginning in the early 1970s, primary chemotherapy has been explored to improve local control and survival in women with large breast tumors or inflammatory breast cancer. Primary chemotherapy produced regression of breast cancer in 60–90% of women (1) and made a significant impact on survival in inflammatory and locally advanced disease. Although primary chemotherapy was incorporated into standard treatment algorithms for select tumors such as Ewing’s sarcoma, and carcinomas, and locally advanced and inflammatory breast cancer, its role in the treatment of resectable breast cancer is undefined. The rationale, benefits, and disadvantages of neoadjuvant chemotherapy in the treatment of operable breast cancer with a primary focus on the randomized clinical trials examining this modality are reviewed here. Recommendations on critical questions and potential future directions in this modality are addressed.


Breast Cancer Breast Conservation Operable Breast Cancer Primary Chemotherapy National Surgical Adjuvant Breast 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Swain S, Lippman M (1989) Systemic therapy of locally advanced breast cancer: review and guidelines. Oncology 3, 21–28.PubMedGoogle Scholar
  2. 2.
    Gradishar W (1998) Primary chemotherapy regimens and schedules. Semin. Oncol. 25, 25–30.PubMedGoogle Scholar
  3. 3.
    Schwartz GF, Birchansky CA, Komarnicky LT, et al. (1994) Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast. Cancer 73, 362–369.PubMedCrossRefGoogle Scholar
  4. 4.
    Chang J, Powles TJ, Allred DC, et al. (1999) Biologic markers as predictors of clinical outcome from systemic therapy for primary operable breast cancer. J. Clin. Oncol. 17, 3058–3063.PubMedGoogle Scholar
  5. 5.
    Powles T, Hickish T, Makris A, et al. (1995) Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J. Clin. Oncol. 13, 547–552.PubMedGoogle Scholar
  6. 6.
    Harris L, Swain S (1996) The role of primary chemotherapy in early breast cancer. Semin. Oncol. 23, 31–42.PubMedGoogle Scholar
  7. 7.
    Nissen-Meyer R, Kjellgren K, Mansson B (1982) Adjuvant chemotherapy in breast cancer. Cancer Res. 80, 142–148.Google Scholar
  8. 8.
    Combination adjuvant chemotherapy for node-positive breast cancer: inadequacy of a single perioperative cycle (1988) Ludwig Breast Cancer Study Group. N. Engl. J. Med. 319, 677–683.Google Scholar
  9. 9.
    Legler C, Shapiro C, Harris J, Hayes D (1995) Primary chemotherapy of resectable breast cancer. Breast J. 1, 42–51.CrossRefGoogle Scholar
  10. 10.
    Fisher B, Gunduz N, Saffer E (1983) Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases. Cancer Res. 43, 1488–1492.PubMedGoogle Scholar
  11. 11.
    Fisher B, Gundu N, Coyle J, Rudock C, Saffer E (1989) Presence of a growth-simulating factor in serum following primary tumor removal in mice. Cancer Res. 49, 1996–2001.PubMedGoogle Scholar
  12. 12.
    Layfield L, Glasgow GJ, Cramer H (1989) Fine needle aspiration in the management of breast masses. Pathol. Annu. 24, 23–62.PubMedGoogle Scholar
  13. 13.
    Donegan WL (1992) Evaluation of a palpable breast mass. N. Engl. J. Med. 327, 937–942.PubMedCrossRefGoogle Scholar
  14. 14.
    Minkowitz S, Moskowitz R, Khafif RA, Alderete MN (1986) Trucut needle biopsy of the breast. An analysis of its specificity and sensitivity. Cancer 57, 320–323.PubMedCrossRefGoogle Scholar
  15. 15.
    Hait WN, Toppmeyer DL, Dipaola RS (1999) Medical treatment of breast cancer. In: Hait WN (ed.) Expert Consulations in Breast Cancer. Marcel Dekker, New York, pp. 69–88.Google Scholar
  16. 16.
    Muss H, Thor A, Berrtm D, et al. (1994) c-erbB-2 expression and response to adjuvant therapy in women with node-positive early breast cancer. N. Engl. J. Med. 330, 1260–1266.Google Scholar
  17. 17.
    Gusterson BA, Gelber RD, Goldhirsch A, et al. (1992) Prognostic importance of c-erB-2 expression in breast cancer. J. Clin. Oncol. 10, 1049–1256.PubMedGoogle Scholar
  18. 18.
    Vera R, Albanell J, Lirola JL, et al. (1999) HER2 overexpression as a predictor of survival in a trial comparing adjuvant FAC and CMF in breast cancer. Proc. Am. Soc. Clin. Oncol. 18, 71a (Abst 265 ).Google Scholar
  19. 19.
    Menard S, Valaguss P, Pilotti S, et al. (1999) Benefit of CMF treatment in lymph node-positive breast cancer overexpressing HER2. Proc. Am. Soc. Clin. Oncol. 18, 69a (Abst 257 ).Google Scholar
  20. 20.
    Henderson IC, Berry D, Demetri G, et al. (1998) Improved disease-free and overall survival from the addition of sequential paclitaxel but not from the escalation of doxorubicin dose level in the adjuvant chemotherapy of patients with node-positive primary breast cancer. Proc. Am. Soc. Clin. Oncol. 17, 101a (Abst 390A ).Google Scholar
  21. 21.
    Mamounas E (1998) Overview of national surgical adjuvant breast project neoadjuvant chemotherapy studies. Semin. Oncol. 25, 31–35.PubMedGoogle Scholar
  22. 22.
    Peters W, Rosner G, Vrenenburgh J, et al. (1999) A prospective randomized comparison of two doses of combination alkylating agents as consolidation after CAF in high-risk primary breast cancer involving ten or more axillary lymph nodes: preliminary results of CALGB 9082/SWOG9114/NCIC MA-13. Proc. ASCO 18, la.Google Scholar
  23. 23.
    Results from a randomized adjuvant breast cancer study with high dose chemotherapy with CTCb supported by autologous bone marrow stem cells versus dose escalated and tailored FEC therapy (1999) The Scandinavian Breast Cancer Study Group 9401. Proc. ASCO 18, 2a.Google Scholar
  24. 24.
    Bezwoda WR (1999) Randomized, controlled trial of high dose chemotherapy (HD-CNVp) versus standard dose (CAF) chemotherapy for high risk, surgically treated, primary breast cancer. Proc. ASCO 18, 2a.Google Scholar
  25. 25.
    Kuerer HM, Newman LA, Smith TL, et al. (1999) Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J. Clin. Oncol. 17, 460–469.PubMedGoogle Scholar
  26. 26.
    Ferriere JP, Assier I, Cure H, Charrier S, Kwiatkowski F (1998) Primary chemotherapy in breast cancer correlation between tumor response and patient outcome. Am. J. Clin. Oncol. 21, 117–120.PubMedCrossRefGoogle Scholar
  27. 27.
    Fisher B, Brown A, Mamounas E, et al. (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B18. J. Clin. Oncol. 15, 2483–2493.PubMedGoogle Scholar
  28. 28.
    Mauriac L, MacGrogan G, Avril A, et al. (1999) Neoadjuvant chemotherapy or operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Ann. Oncol. 10, 47–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Semiglazov V, Topuzov E, Bavli J, et al. (1994) Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIb breast cancer. Ann. Oncol. 5, 591–595.PubMedGoogle Scholar
  30. 30.
    Bonnadonna G, Valagussa P (1996) Primary chemotherapy in operable breast cancer. Semin. Oncol. 23, 464–474.Google Scholar
  31. 31.
    Brenin D, Morrow M (1998) Breast-conserving surgery in the neoadjuvant setting. Semin. Oncol. 25, 13–18.PubMedGoogle Scholar
  32. 32.
    Bonnadonna G, Veronesi U, Brambilla C, et al. (1990) Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J. Natl. Cancer Inst. 82, 1539–1545.CrossRefGoogle Scholar
  33. 33.
    Calais G, Berger C, Descamps P, et al. (1994) Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm. Cancer 74, 1283–1288.PubMedCrossRefGoogle Scholar
  34. 34.
    Jacquillat C, Weil M, Baillet R, et al. (1990) Results of neoadjuvant chemotherapy and radiation therapy in the breast conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer 66, 119–129.PubMedCrossRefGoogle Scholar
  35. 35.
    Belembaogo E, Feillel V, Chollet P, et al. (1992) Neoadjuvant chemotherapy in 126 operable breast cancers. Eur. J. Cancer Clin. Oncol. 28A, 896–900.Google Scholar
  36. 36.
    Smith I, Jones A, O’Brien M, McKinna J, Sacks N, Baum M (1993) Primary medical (neoadjuvant) chemotherapy for operable breast cancer. Eur. J. Cancer Clin. Oncol. 29A, 1796–1799.Google Scholar
  37. 37.
    Bonadonna G, Valagussa P, Zucali R, et al. (1995) Primary chemotherapy in surgically resectable breast cancer. CA Cancer J. Clin. 45, 227–243.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Deborah L. Toppmeyer

There are no affiliations available

Personalised recommendations