Update on neoadjuvant/preoperative therapy of breast cancer: experiences from the German Breast Group

Neoadjuvant treatment is used by an increased number of patients with breast cancer. This study reviews the current literature on how new research findings have impacted patients and treatment selection.

The prognostic value of pathological complete response (pCR) is different in various breast cancer subtypes. pCR rate after neoadjuvant chemotherapy is associated with better outcome only for patients with human epidermal growth factor receptor 2 (HER2)-positive/hormone receptor negative or HER2-negative/hormone receptor negative (triple-negative) and some more aggressive HER2-negative/hormone receptor positive tumours. Knowledge on pCR in these subtypes can relieve patients from an initially unfavourable prognosis. For patients without a pCR, especially if a high proliferation can be detected in the residual tumour after neoadjuvant treatment, prognosis is still unfavourable and clinical trials exploring new targeted agents in this postneoadjuvant indication are currently under development. Neoadjuvant treatment allows treatment to be guided by monitoring response. Changing the regimen in case of no early response or intensification in case of early response has shown significant survival advantages especially in patients with hormone receptor positive tumours.

The model of neoadjuvant chemotherapy has been improved over the last decade and is now successfully used to increase our knowledge not only on the pathophysiology of the disease but also on the activity of conventional and new treatment approaches.