[Neoadjuvant systemic therapy for breast cancer]

Neoadjuvant systemic treatment (NST) remains important approach for the assessment of biological and clinical effects of new methods of treatments in clinical trials. Recent trials failed to support that pathological complete response (pCR) after NST is an early surrogate end point of treatment efficacy. This may limit the use of NST in operable breast cancer in clinical routine. Pathological complete response (pCR) is a relatively "late" end point, and therefore new early predictors of treatment efficacy are needed in order to timely change for futile therapy. After NST an accurate management of post-treatment residual disease is mandatory. Sentinel lymph-node (SLN) surgery is an acceptable option to spare axillary dissection in case of SLN negative disease. No data support the modulation of the extent of loco-regional radiation therapy on the basis of the response attained after NST.