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Related Experiment Videos

Primary systemic therapy in operable breast cancer.

A C Wolff1, N E Davidson

  • 1Johns Hopkins Oncology Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21231-1000, USA. awolff@jhmi.edu

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|March 29, 2000
PubMed
Summary

Primary systemic therapy (PST) in operable breast cancer shows a small increase in breast conservation rates but no clear survival benefit over adjuvant therapy. Further research is needed to identify patient subsets and biomarkers for improved outcomes.

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Area of Science:

  • Oncology
  • Translational Research
  • Clinical Trials

Background:

  • Laboratory studies suggest primary systemic therapy (PST) may improve control of micrometastatic disease and overall survival (OS) in operable breast cancer.
  • PST involves administering systemic therapy before surgery to manage potentially widespread microscopic disease.

Purpose of the Study:

  • To examine the rationale, preclinical, and clinical data for PST in operable breast cancer.
  • To evaluate the role of intermediate biomarkers as predictive or prognostic factors for treatment response and survival.

Main Methods:

  • Extensive literature review including MEDLINE database searches.
  • Inclusion of preclinical studies, single-arm feasibility studies, and large randomized clinical trials.
  • Analysis of laboratory correlate studies investigating biomarkers in breast cancer.

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Main Results:

  • Small trials in locally advanced disease showed high initial response and local control rates.
  • Six randomized clinical trials (RCTs) in palpable, operable breast cancer demonstrated a small (<10%) absolute increase in breast-conservation treatment (BCT) rates with similar local control.
  • Most studies did not show a survival advantage for PST over adjuvant therapy, though pathologic complete response appears to be the best survival predictor.

Conclusions:

  • Current RCTs of PST versus standard adjuvant therapy have not shown clear benefits in disease-free survival (DFS) or OS for early breast cancer.
  • Ongoing trials aim to identify patient subsets benefiting from additional systemic therapy and the role of biomarkers.
  • PST is an acceptable alternative for women with operable tumors, offering increased BCT rates, but should not replace standard adjuvant approaches.