In this E-Learning module, the author underlines that neoadjuvant therapy has an important and clear role in the management of breast cancer with a multidisciplinary management being crucial. By providing an overview of general principles of neoadjuvant therapy, the author focuses on elaborating the results of neoadjuvant studies in different subtypes of breast cancer.
The neoadjuvant therapy is standard of care for the majority of patients with stages IIB and III breast cancer. It increases the operability of locally advanced breast cancer, the chance of breast conserving surgery for mastectomy candidates and the conversion of lymph node positive to lymph node negative status. The neoadjuvant therapy affords similar survival outcomes as compared to adjuvant systemic therapy. It also allows for in vivo evaluation of treatment sensitivity.
The author elaborates neoadjuvant treatment approaches for HER2-positive breast cancer subtype, triple negative breast cancer and luminal breast cancer. These parts of the module are illustrated by findings from different clinical trials that the author positions in terms of standard clinical practice, opening a new research era and reshaping the model.
The author also elaborates the pathologic complete response (pCR) and its prognostic value. The author also emphasizes that, in order to better identify patients with pCR who are eligible for de-escalated systemic treatment, future research should be more focused on factors associated with distant events and on predictors of both pCR and event-free survival.
The author also states that with neoadjuvant studies, the triage of new agents is faster and cheaper. Post-neoadjuvant studies allow for a rational clinical positioning of new agents. Furthermore, post-neoadjuvant strategy considering the biology of residual disease might further improve the cure rate.
This E-learning module is an excellent educational opportunity to look into the evolving role of neoadjuvant therapy in patient with breast cancer and attempts to personalise breast cancer care.
