Neoadjuvant treatment of breast cancer--Clinical and research perspective

Neoadjuvant therapy is very often an adequate alternative to adjuvant therapy. This review is summarizing the recent advances made in the area of neoadjuvant therapy in breast cancer. The focus will lie on recently published clinical trials but will not further highlight surgical, imaging and radiooncological issues related to neoadjuvant therapy.

Within the last 1-1.5 years it has been discussed if neoadjuvant treatment can be used as faster way to get access to new therapies, based on new data in HER2+ breast cancer suggesting a higher pCR rate when a dual anti-HER2 therapy was used. Nevertheless this higher pCR rate does not necessarily translate always into a better survival. In TNBC carboplatin could be identified as an asset for patients, especially in patients with gBRCA mutations. However, mature long term data are still missing. The neoadjuvant approach is ideal to identify new biomarkers which predict response or resistance to the given treatment. Tumour infiltrating lymphocytes and PIK3CA mutations are amongst the most promising markers.

Neoadjuvant treatment should be considered for all patients with HER2-positive or triple negative breast cancer. Clinical trials in this setting are currently investigating new approaches.