Neoadjuvant Chemotherapy for Breast Cancer: Who Should Get It?

Abstract

Neoadjuvant chemotherapy plays a critical role for patients eligible for preoperative therapy; especially for those with HER2-positive or triple-negative breast cancer. Advances in systemic therapy have led to increased rates of pathological complete response (pCR), a key indicator of long-term outcomes and a guide for subsequent adjuvant treatments. pCR also serves as a surrogate marker for the approval of new drugs in breast cancer. Neoadjuvant chemotherapy enhances the feasibility of breast-conserving surgery and sentinel lymph node biopsy for patients showing a clinical response. Effective management requires collaboration with a multidisciplinary team—including medical oncologists, surgical oncologists and radiation oncologists—prior to starting treatment. This is to consider therapy sequencing, its results in various treatment options, and appropriate management of breast and axillary nodes for potential de-escalation. Future advancements in personalized therapy involve identifying patients with exceptional responses to neoadjuvant chemotherapy whom may be able to avoid surgery entirely, and developing strategies to tailor neoadjuvant regimens using predictive biomarkers.