Application of neoadjuvant chemoendocrine therapy for operable breast carcinomas

The use of neoadjuvant chemotherapy in primary breast cancer is based on sound theoretical, experimental and clinical principles. Higher objective response rates have been seen in patients with locally advanced breast carcinoma. Furthermore, when used in patients with operable breast carcinomas, sufficient downstaging has been achieved to allow for breast conservation surgery in patients who would otherwise require a mastectomy. This has been achieved without an increase in local recurrence. The anthracenedione mitoxantrone was used as part of the 3M/2M regimen in the neoadjuvant trial at the Royal Marsden Hospital, which was the first to establish within the setting of a clinical trial, the reduction in mastectomy requirements. This regimen combined high objective response rate with low symptomatic toxicity. An important benefit of neoadjuvant therapy is the opportunity to study in vivo the effects of treatment in primary breast carcinomas. The use of the primary tumour as a marker of response prior to surgery may, in the future, allow for the optimization of therapy for individual patients.