Neoadjuvant chemotherapy in breast cancer: what questions remain?

Although neoadjuvant therapy (NAT) has become a popular approach in the systemic management of breast cancer, several important clinical questions remain unanswered. In this article, we review the literature pertaining to these questions and discuss the management strategies based on our findings.

Currently, the optimal duration of NAT is unclear. At this time, there is no compelling data to support the extension of traditional neoadjuvant chemotherapy regimens. In patients with triple-negative breast cancer, pathologic complete response may be prognostic and the appropriate use of neoadjuvant chemotherapy is crucial to achieve improved survival. In human epidermal growth factor receptor 2 (HER2)-positive disease, it is reasonable to consider dual blockade with trastuzumab and pertuzumab in combination with a taxane in the neoadjuvant setting. Finally, there is currently no evidence to support the use of further adjuvant chemotherapy in those patients with residual disease after NAT.

There remain many unanswered questions with the use of neoadjuvant chemotherapy in breast cancer, and further randomized clinical trials are needed. The results of these trials will permit the clinicians to develop 'personalized' treatment approaches, thus giving women the best chance of survival.