Adjuvant/Neoadjuvant Systemic Therapies in Breast Cancer

  • Radhakrishna Selvi


Breast cancer is the most common cancer in females in Western countries [1]. The most recent Globocan data shows that it is also the most common cancer in women in Indian women [2]. Though it seems to be one disease, it is quite heterogeneous with different subtypes behaving differently to different therapeutic strategies. There has been substantial improvement in the outcome due to adjuvant therapy in breast cancer management over last few decades.


Breast Cancer Overall Survival Adjuvant Chemotherapy Operable Breast Cancer 
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  1. 1.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.PubMedCrossRefGoogle Scholar
  2. 2.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon: International Agency for Research on Cancer; 2013.Google Scholar
  3. 3.
    Peto R, Davies C, et al; Early Breast Cancer Trialists’ Collaborative Group. 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.Google Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    Bland CS. The Halsted mastectomy: present illness and past history. West J Med. 1981;134(6):549–55.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Fisher B. Systemic chemotherapy as an adjuvant to surgery in the treatment of breast cancer. Cancer. 1969;24(6):1286–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med. 1976;294(8):405–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Fisher B, Redmond C, Elias EG, et al. Adjuvant chemotherapy for breast cancer: an overview of NSABP findings. Int Adv Surg Oncol. 1982;5:65–90.PubMedGoogle Scholar
  9. 9.
    Fisher B. A biological perspective of breast cancer: contributions of the National Surgical Adjuvant Breast and Bowel Project clinical trials. CA Cancer J Clin. 1991;41(2):97–111.PubMedCrossRefGoogle Scholar
  10. 10.
    Eifel P, Axelson JA, Costa J, et al. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst. 2001;93(13):979–89.PubMedCrossRefGoogle Scholar
  11. 11.
    Fisher B, Dignam J, Tan-Chiu E, et al. Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. J Natl Cancer Inst. 2001;93(2):112–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Azim Jr HA, de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol. 2011;22(9):1939–47.PubMedCrossRefGoogle Scholar
  13. 13.
    Schwartz GF, Bartelink H, Burstein HJ, et al. Adjuvant therapy in stage I carcinoma of the breast: the influence of multigene analyses and molecular phenotyping. Breast J. 2012;18(4):303–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Foulkes WD. Size surprise? Tumour size, nodal status, and outcome after breast cancer. Curr Oncol. 2012;19(5):241–3.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Pritchard KI, Shepherd LE, O’Malley FP, et al. HER2 and responsiveness of breast cancer to adjuvant chemotherapy. N Engl J Med. 2006;354(20):2103–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011;365(14):1273–83.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Bartlett JM, Munro AF, Dunn JA, et al. Predictive markers of anthracycline benefit: a prospectively planned analysis of the UK National Epirubicin Adjuvant Trial (NEAT/BR9601). Lancet Oncol. 2010;11(3):266–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Inwald EC, Klinkhammer-Schalke M, Hofstadter F, et al. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat. 2013;139(2):539–52.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    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(9):2206–23.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Donehower RC, Rowinsky EK, Grochow LB, Longnecker SM, Ettinger DS. Phase I trial of taxol in patients with advanced cancer. Cancer Treat Rep. 1987;71(12):1171–7.PubMedGoogle Scholar
  21. 21.
    Bonadonna G, Valagussa P, Moliterni A, Zambetti M, Brambilla C. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. N Engl J Med. 1995;332(14):901–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Engelsman E, Klijn JC, Rubens RD, et al. “Classical” CMF versus a 3-weekly intravenous CMF schedule in postmenopausal patients with advanced breast cancer. An EORTC Breast Cancer Co-operative Group Phase III Trial (10808). Eur J Cancer. 1991;27(8):966–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Tancini G, Bonadonna G, Valagussa P, Marchini S, Veronesi U. Adjuvant CMF in breast cancer: comparative 5-year results of 12 versus 6 cycles. J Clin Oncol. 1983;1(1):2–10.PubMedGoogle Scholar
  24. 24.
    Fisher B, Brown AM, Dimitrov NV, et al. Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15. J Clin Oncol. 1990;8(9):1483–96.PubMedGoogle Scholar
  25. 25.
    Fisher B, Anderson S, Tan-Chiu E, et al. Tamoxifen and chemotherapy for axillary node-negative, estrogen receptor-negative breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-23. J Clin Oncol. 2001;19(4):931–42.PubMedGoogle Scholar
  26. 26.
    Hutchins LF, Green SJ, Ravdin PM, et al. Randomized, controlled trial of cyclophosphamide, methotrexate, and fluorouracil versus cyclophosphamide, doxorubicin, and fluorouracil with and without tamoxifen for high-risk, node-negative breast cancer: treatment results of Intergroup Protocol INT-0102. J Clin Oncol. 2005;23(33):8313–21.PubMedCrossRefGoogle Scholar
  27. 27.
    No author listed. A prospective randomized phase III trial comparing combination chemotherapy with cyclophosphamide, fluorouracil, and either doxorubicin or epirubicin. French Epirubicin Study Group. J Clin Oncol. 1988;6(4):679–88.Google Scholar
  28. 28.
    Holmes FA, Walters RS, Theriault RL, et al. Phase II trial of taxol, an active drug in the treatment of metastatic breast cancer. J Natl Cancer Inst. 1991;83(24):1797–805.PubMedCrossRefGoogle Scholar
  29. 29.
    Winer EP, Berry DA, Woolf S, et al. Failure of higher-dose paclitaxel to improve outcome in patients with metastatic breast cancer: cancer and leukemia group B trial 9342. J Clin Oncol. 2004;22(11):2061–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Henderson IC, Berry DA, Demetri GD, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol. 2003;21(6):976–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Mamounas EP, Bryant J, Lembersky B, et al. Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28. J Clin Oncol. 2005;23(16):3686–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Eiermann W, Pienkowski T, Crown J, et al. Phase III study of doxorubicin/cyclophosphamide with concomitant versus sequential docetaxel as adjuvant treatment in patients with human epidermal growth factor receptor 2-normal, node-positive breast cancer: BCIRG-005 trial. J Clin Oncol. 2011;29(29):3877–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005;352(22):2302–13.PubMedCrossRefGoogle Scholar
  34. 34.
    Wildiers H, Forceville K, Paridaens R, Joensuu H. Taxanes and anthracyclines in early breast cancer: which first? Lancet Oncol. 2010;11(3):219–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med. 2008;358(16):1663–71.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol. 2003;21(8):1431–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Jones S, Holmes FA, O’Shaughnessy J, et al. Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735. J Clin Oncol. 2009;27(8):1177–83.PubMedCrossRefGoogle Scholar
  38. 38.
    Martin M, Villar A, Sole-Calvo A, et al. Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group. Ann Oncol. 2003;14(6):833–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Basch E, Hesketh PJ, Kris MG, Prestrud AA, Temin S, Lyman GH. Antiemetics: american society of clinical oncology clinical practice guideline update. J Oncol Pract. 2011;7(6):395–8.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 2007;94(10):1189–200.PubMedCrossRefGoogle Scholar
  41. 41.
    Schott AF, Hayes DF. Defining the benefits of neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2012;30(15):1747–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Cuppone F, Bria E, Carlini P, et al. Taxanes as primary chemotherapy for early breast cancer: meta-analysis of randomized trials. Cancer. 2008;113(2):​238–46.PubMedCrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    von Minckwitz G, Kummel S, Vogel P, et al. Neoadjuvant vinorelbine-capecitabine versus docetaxel-doxorubicin-cyclophosphamide in early nonresponsive breast cancer: phase III randomized GeparTrio trial. J Natl Cancer Inst. 2008;100(8):542–51.CrossRefGoogle Scholar
  45. 45.
    Chagpar AB, Middleton LP, Sahin AA, et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg. 2006;243(2):257–64.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • Radhakrishna Selvi
    • 1
  1. 1.Chennai Breast CentreChennaiIndia

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