Abstract
• Theoretically if the tumour has not yet disseminated metastases to tissues that are biologically vital, it is curable with local therapy only. • Approximately half of women with operable breast BC who do not receive any systemic therapy will die from metastatic disease. • Randomised trials have shown that adjuvant treatment (endocrine therapy, chemotherapy or molecular-targeted agents) significantly improves survival. • Adjuvant systemic therapies, including chemotherapy, should be considered for all patients with BC when benefit outweighs risks.
Future directions. The response to neoadjuvant chemotherapy in vivo could provide a useful prediction of prognosis and helps define strategies for an individual patient’s future treatment with alternative chemotherapy regimens or molecular-targeting agents. Furthermore, the discovery of predictive markers for tumour response to neoadjuvant chemotherapy may also help facilitate individualised chemotherapy, particularly in patients, as those with triple-negative BC, with a poor prognosis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013;24:2206–23.
NCCN guidelines 2014. www.nccn.org. Accessed 20 June 2014.
Davies C, Godwin J, Gray R, et al. on behalf of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378:771–84.
Eisen A, Trudeau M, Shelley W, Messersmith H, Pritchard KI. Aromatase inhibitors in adjuvant therapy for hormone receptor positive breast cancer: a systematic review. Cancer Treat Rev. 2008;34:157–74.
Davies C, Pan H, Godwin J, et al. on behalf of the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381:805–16.
Goss PE, Ingle JN, Pater JL, et al. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. J Clin Oncol. 2008;26(12):1948–55.
Goel S, Sharma R, Hamilton A, Beith J. LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women. Cochrane Database Syst Rev. 2009;(4):CD004562.
Peto R, Davies C, Godwin J, et al. on behalf of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012;379(9814):432–44.
Senkus E, Kyriakides S, Penault-Llorca F, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi7–23.
Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol. 2014;15:640–7.
Mauri D, Pavlidis N, Ioannidis JPA. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:188–94.
Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.
Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13:25–32.
Cardoso F, Costa A, Norton L, et al. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast. 2014;23:489–502.
Partridge AH, Rumble BR, Carey LA, et al. Chemo- and targeted therapy for women with HER2 negative (or unknown) advanced breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. http://jco.ascopubs.org/content/32/29/3307.full.pdf+html.
Further Reading
Amir E, Seruga B, Niraula S, et al. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst. 2011;103:1299–309.
Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update. http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2013.54.2258. Accessed 30 Jan 2015.
De Melo GD, Gonzalez-Angulo A, Lei X, et al. Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol. 2014;32:735–44.
Dhesy-Thind SK. Screening for osteoporosis in postmenopausal women with breast cancer receiving aromatase inhibitors: less is more? J Clin Oncol. 2012;30:1408–10.
Smith IE, Dowsett M, Yap YS, et al. Adjuvant aromatase inhibitors for early breast cancer after chemotherapy-induced amenorrhoea: caution and suggested guidelines. J Clin Oncol. 2006;24:2444–7.
Untch M, Konecny GE, Paepke S, von Minckwitz G. Current and future role of neoadjuvant therapy for breast cancer. Breast. 2014;23:526–37.
Websites in Appendix: Advanced BC A-4.1; Adjuvant Systemic Therapy, A-4.2; Clinical Trials, A-4.6; Fatigue, A-4.8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Pluchinotta, A.M., Ghiotto, C., Baretta, Z. (2015). The Role of Adjuvant Systemic Therapy. In: Pluchinotta, A. (eds) The Outpatient Breast Clinic. Springer, Cham. https://doi.org/10.1007/978-3-319-15907-2_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-15907-2_18
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15906-5
Online ISBN: 978-3-319-15907-2
eBook Packages: MedicineMedicine (R0)