Over the past decade, there has been increasing use of neoadjuvant chemotherapy (given after a biopsy but before the primary surgery, either wide excision or mastectomy) for some women with larger breast tumors or who are otherwise thought to be better treated with immediate systemic therapy. In the case of larger tumors, the hope is that the chemotherapy will shrink the primary tumor in the breast and make it possible for the woman to have a wide excision/lumpectomy rather than a mastectomy. This is an abstract from a study done recently at M. D. Anderson in Houston and published in the Journal of Clinical and Translational Oncology about the value of this strategy. After the abstract, there is a link if you want to read more:
Mariana Chávez-MacGregor1 and Ana María González-Angulo2
(1) Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
(2) Departments of Breast Medical Oncology and Systems Biology, The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Boulevard Unit 1354, TX 77030-4009 Houston, USA
Received: 14 April 2010 Accepted: 24 May 2010 Published online: 20 July 2010
Neoadjuvant systemic therapy (NST) has become part of the standard treatment of patients with locally advanced breast cancer. Patients who achieve a pathologically complete response (pCR) after NST have improved outcomes compared with patients with residual disease at the primary tumor site or the lymph nodes. Achieving a pCR after NST correlates with improved disease-free and overall survival; therefore the amount of residual disease is a prognostic predictor, and it is an area of ongoing research. In this article, we review the literature on NST to highlight the importance of pCR as a prognostic indicator. We also review the definition of pCR and describe the association between different patient and tumor characteristics, including the breast cancer
subtype classification, and its response to chemotherapy. We expand on the clinical impact of residual disease and comment on the importance of quantifying it and the current treatment recommendations for patients with residual disease after NST.