Background: Neoadjuvant treatment is increasingly one of the preferred therapeutic options for early breast cancer and may have some unique outcomes, such as identifying predictive and prognostic factors of response or increasing the knowledge of individual tumor biology.
Design: A panel of experts from different specialties reviewed published clinical studies on the neoadjuvant management of breast cancer. Recommendations were made that emphasized the clinical multidisciplinary management and the investigational leverage in early breast cancer.
Results: Neoadjuvant therapy has equivalent efficacy to adjuvant therapy, and it has some additional benefits that include increasing breast conservation, assessing tumor response, establishing prognosis based on the pathological response, and providing a "second opportunity" for nonresponding patients. Achieving pathological complete remission because of neoadjuvant therapy has been correlated with long-term clinical benefit, particularly in HER2-positive and triple-negative breast cancer. In addition, the neoadjuvant setting is a powerful model for the development of new drugs and the identification of prognostic markers. Finally, neoadjuvant therapy has proven to be cost-effective by reducing nondrug costs, avoiding radical surgery, and reducing hospital stays when compared with other treatment approaches.
Conclusion: Neoadjuvant therapy has clinical benefits in early breast cancer and provides in vivo information of individual breast cancer biology while allowing the investigation of new treatment approaches. Access to neoadjuvant therapy should be an option available to all patients with breast cancer through multidisciplinary tumor management.
Implications for practice: Neoadjuvant treatment should be strongly considered as a therapeutic option for localized breast cancer and is a powerful tool for understanding breast cancer biology and investigating new treatment approaches.
摘要
背景。新辅助治疗越来越成为早期乳腺癌的治疗首选方案之一，并且可能具有一些独特的结果，例如识别缓解的预测和预后因素或增加个体肿瘤生物学的认识。
设计。来自不同专业的专家小组审查了关于乳腺癌新辅助治疗的已发表的临床研究。提出了在早期乳腺癌中强调临床多学科管理和研究的最大限度利用的建议。
结果。新辅助治疗具有与辅助治疗相同的功效，并且还具有一些额外的获益，包括增加保乳手术，评估肿瘤缓解，基于病理缓解确定预后，以及为无缓解的患者提供“第二次机会”。由于新辅助治疗而实现病理性完全缓解与长期临床获益相关，特别是在 HER2 阳性和三阴性乳腺癌中。此外，新辅助治疗是开发新药和确定预后标志物的有力模型。最后，与其他治疗方法相比，新辅助治疗通过降低非药物成本，避免根治性手术和减少住院时间而被证明具有成本效益。
结论。新辅助治疗在早期乳腺癌中具有临床益处，并提供个体乳腺癌生物学的体内信息，同时允许研究新的治疗方法。通过多学科肿瘤管理，所有乳腺癌患者应该都可以选择接受新辅助治疗。
实践意义:应强烈考虑将新辅助治疗作为局部乳腺癌的治疗方案，新辅助治疗是了解乳腺癌生物学和研究新治疗方法的有力工具。
Keywords: Chemotherapy; Cost analysis; HER therapy; Hormonal therapy; Surgery.
© AlphaMed Press 2019.