Locally advanced breast cancer

Area of Science:

• Oncology
• Breast Cancer Research
• Clinical Therapeutics

Background:

• Locally advanced breast cancer (LABC) prognosis has improved with multimodal therapy over 20 years.
• Neoadjuvant chemotherapy (NAC) enables breast-conserving surgery (BCS) and resections in inoperable LABC.
• Pathologic complete response (CR) rates with NAC are low, and survival correlates with residual disease.

Purpose of the Study:

• To review current multimodal treatment strategies for LABC.
• To evaluate the impact of chemotherapy regimens, surgical techniques, and adjuvant therapies on LABC outcomes.
• To identify areas for improvement in LABC management.

Main Methods:

• Review of anthracycline-based NAC regimens and taxane additions.
• Analysis of surgical approaches including BCS, partial mastectomy, and lymph node dissection (SLN sampling).
• Evaluation of adjuvant therapies (chemotherapy, hormonal therapy, radiation) and their impact on disease-free survival (DFS) and overall survival (OS).

Main Results:

• Taxane-containing regimens increase response rates and may improve DFS.
• BCS is oncologically safe for most LABC patients, with modified nodal dissection reducing morbidity.
• Adjuvant tamoxifen improves outcomes in hormone receptor-positive (HR+) tumors; ovarian ablation is considered for premenopausal patients.
• Postoperative radiation reduces locoregional recurrences, but OS impact is debated.
• Neoadjuvant hormonal therapy may benefit frail patients with HR+ tumors.

Conclusions:

• Multimodal therapy, including NAC with taxanes and appropriate surgical techniques, has significantly improved LABC outcomes.
• Adjuvant hormonal therapy is crucial for HR+ LABC. Further research is needed on radiation's OS impact.
• Current targeted therapies like trastuzumab lack a proven role in LABC management.