Neoadjuvant therapy in early-stage breast cancer

Neoadjuvant (preoperative) chemotherapy is becoming a commonly used option for women with early-stage breast cancer, allowing a greater proportion of patients to undergo breast conservation surgery. Neoadjuvant chemotherapy also allows the early assessment of response or resistance to chemotherapy and facilitates chemotherapy delivery prior to any surgical alterations to the vasculature. Ongoing research is examining the potential benefits of neoadjuvant therapy with cytotoxic agents as well as other treatments, including endocrine therapies and biologic agents. Additionally, biomarkers are being intensively investigated as methods for identifying patients who will most likely benefit from neoadjuvant chemotherapy. As of yet, neoadjuvant chemotherapy has not demonstrated a definitive benefit over adjuvant (postoperative) chemotherapy with regard to prolonging survival. It remains to be seen whether novel cytotoxic agents used in the neoadjuvant setting will improve pathologic clinical response rates and ultimately improve long-term outcome in women with early-stage breast cancer.