Locally advanced breast cancer.

Area of Science:

• Oncology
• Breast Cancer Research
• Clinical Therapeutics

Background:

• Locally advanced breast cancer (LABC) is inoperable adenocarcinoma without distant metastases.
• LABC incidence (stages IIIB and IIIC) has declined, with limited separate investigation in clinical trials.
• Treatment is often extrapolated from studies of less or more advanced disease.

Purpose of the Study:

• To review the current multidisciplinary approach to LABC management.
• To highlight essential diagnostic and therapeutic strategies.
• To underscore the need for dedicated research efforts in LABC.

Main Methods:

• Review of neoadjuvant chemotherapy, endocrine therapy, targeted agents (anti-HER2), and immunotherapies (PD-1/PD-L1).
• Discussion of surgical options (conservative vs. mastectomy) and radiotherapy indications (pre- and post-operative).
• Emphasis on the role of multidisciplinary teams in optimizing local control and preventing relapse.

Main Results:

• Pathologic confirmation and molecular profiling are crucial for neoadjuvant chemotherapy selection.
• HER2-positive LABC benefits from anti-HER2 agents; PD-1/PD-L1 antibodies show promise in triple-negative LABC.
• Excellent neoadjuvant responses can enable conservative surgery, though mastectomy may be needed for inflammatory breast cancer.

Conclusions:

• Multidisciplinary teams are vital for optimizing LABC treatment and preventing relapses.
• Despite advancements, modest survival improvements necessitate specific research for LABC.
• Further dedicated research is essential to address the unmet needs in LABC patients.