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Pathological Complete Response After Neoadjuvant Chemotherapy in Breast Cancer: A Literature Overview
Anita Gorzelak-Magiera1, Jacek Kabut1, Joanna Sadurska1
1Department of Oncology and Radiotherapy, Medical University of Silesia, 40-055 Katowice, Poland.
Cancers
|June 12, 2026
Summary
Neoadjuvant chemotherapy (NACT) response in breast cancer is key. Pathological complete response (pCR) indicates good prognosis, while residual disease (RD) suggests higher recurrence risk, guiding further treatment decisions.
Area of Science:
- Oncology
- Translational Research
- Clinical Trials
Background:
- Breast cancer remains a leading cause of mortality in women globally.
- Neoadjuvant chemotherapy (NACT) improves breast-conserving surgery rates and identifies high-risk patients.
- Pathological complete response (pCR) signifies treatment success, contrasting with residual disease (RD) indicating higher recurrence risk.
Purpose of the Study:
- To review the clinical and prognostic significance of pCR and RD in breast cancer patients undergoing NACT.
- To analyze evidence from clinical trials, meta-analyses, and guidelines on contemporary systemic treatments.
- To explore treatment strategies based on pathological response across different breast cancer subtypes.
Main Methods:
- Systematic review of randomized clinical trials and meta-analyses.
- Analysis of current clinical guidelines for breast cancer systemic treatment.
- Synthesis of evidence on pathological response and patient outcomes.
Main Results:
- pCR rates vary by tumor subtype, highest in triple-negative and HER2-positive (non-luminal) breast cancer.
- HER2-targeted therapies combined with chemotherapy improve pCR in HER2-positive disease; RD may warrant antibody-drug conjugates.
- Platinum agents and immune checkpoint inhibitors enhance TNBC efficacy; PARP inhibitors improve survival in HER2-negative/BRCA-mutated disease, independent of pCR.
Conclusions:
- Pathological response to NACT is a critical prognostic indicator in breast cancer.
- Treatment selection and escalation strategies should be tailored to tumor subtype and pathological response.
- Further research is needed to integrate biomarkers like ctDNA and refine treatment decisions based on residual disease characteristics.
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