Neoadjuvant strategy usher in a new era of quasi-individualized treatment for early breast cancer / 国际外科学杂志

ABSTRACT

Treatment sequencing in early-stage breast cancer has significantly changed in recent years. Instead of surgery-adjuvant chemotherapy mode, several clinical trials showed benefits using administering systemic chemotherapy (and human epidermal growth factor receptor 2 targeted therapies) prior to surgery. Neoadjuvant therapy (NAT) could frequently downstage the primary tumor and lymph nodes, allowing conversion of the planned surgery form inoperable to operable one, from a mastectomy to a lumpectomy, and potentially allowing omission of axillary lymph node dissection. These benefits also include providing the opportunity to monitor the individual drug response and more accurate prognostic estimates based on the extent of residual cancer that can guide additional adjuvant treatment. This allows escalation or de-escalation of NAT: patients who achieved pathologic complete response could be spared further chemotherapy or de-escalation of locoregional therapies, while those with residual cancer could receive additional systemic therapy postoperatively. NAT is not an option anymore but a platform for personalized breast cancer therapy.