[Neoadjuvant therapy in breast carcinoma]

The preoperative or neoadjuvant chemo- or endocrine therapy in the treatment of locally advanced breast cancer is a new therapy option. Clinical Studies could show, that there is no difference in overall survival between patients, who received a preoperative chemotherapy and patients, treated with the conventionally postoperative, adjuvant chemotherapy. There is an increased rate of breast conserving therapy for the locally advanced breast cancer because of tumor shrinking. Neoadjuvant chemotherapy is also a good in-vivo-model for chemosensitivity-testing. For elderly patients with comorbidity, the primary treatment with endocrine therapy with tamoxifen or aromatase inhibitors could even avoid an operation in some cases. The most effective drugs for preoperative chemotherapy are anthracyclines and taxanes. The assessment of predictive factors like S-phase, Ki67, ploidy, c-erb-B2, in-vitro-chemosensitivity-testing results and others could help to differentiate patients who will have a benefit from chemotherapy. It is important to have more results from studies with a long term follow-up, before we declare primary systemic chemo- or hormone therapy as standard therapy for breast cancer patients with locally advanced breast cancer.