Cancer neoadjuvant therapy

Locally advanced breast cancer often is treated with neoadjuvant therapy to make the tumor surgically respectable. During neoadjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy, and a physical examination and ultrasound exams to detect size of tumor are performed after the cycles of neoadjuvant therapy are completed. After a complete surgical resection, monitoring proceeds as described earlier for early breast cancer. 

Belani CP. Adjuvant and neoadjuvant therapy in non-small cell lung cancer. Semin Oncol 2005 32(2 suppl 2) S9-15. 

Another unique aspect of rectal cancer is the use of neoadjuvant therapy. Preoperative radiation with or without chemotherapy is given to downstage the tumor prior to surgical resection to improve sphincter preservation by making the surgical procedure easier to perform. The issue of preoperative versus postoperative radiation is a subject of debate and investigation in the United States and will require further data to determine the superiority of one method over the other. 

Nelson s syndrome A condition characterized by the aggressive growth of a pituitary tumor and hyperpigmentation of the skin. Neoadjuvant therapy Therapy given prior to the primary treatment. In cancer, it is usually given prior to surgery to make the surgical... 

Simpson D, Plosker GL. Paclitaxel as adjuvant or neoadjuvant therapy in early breast cancer. Drugs 2004 64 1839 7. 

A phase I study of Xeloda in combination with XRT in rectal cancer is in the adjuvant, neoadjuvant, and palliative settings (71-73). The DLT of the combination is hand-foot syndrome and mild to moderate leukopenia, diarrhea, and local skin reaction (71-73). The recommended dose for phase 2 studies is Xeloda 825 mg/m2 twice daily without interruption in combination with standard dose of radiation. Promising activity has been demonstrated in neoadjuvant therapy with six objective responses in seven evaluable patients including one pathological confirmed CR. 

Gonzalez-Larriba J, Garcia Carbonero I, Sastre Valera J, Perez Segura P, Diaz-Rubino E. Neoadjuvant therapy with cisplatin/fluorouracil vs cisplatin/UFT in locally advanced squamous cell head and neck cancer. Oncology (Huntingtj 1997 11(9 Suppl 10) 90-97. 

Pass H, Pogrebniak H, Steinberg SM, et al. Randomized trial of neoadjuvant therapy for lung cancer Interim analysis. Ann Thorac Surg 1992 53 992-1008. 

MeLeod HL, Tan B, Malyapa R et al. Genotype-guided neoadjuvant therapy for rectal cancer. Proc Am Soc Clin Oncol 2005 23 197. 

Kitamura, K., Saeki, H., Kawaguchi, H., Araki, K., Ohno, S., Kuwano, H., Maehara, Y., and Sugimachi, K. 2000. Immunohistochemical status of the p53 protein and Ki-67 antigen using biopsied specimens can predict a sensitivity to neoadjuvant therapy in patients with esophageal cancer. Hepato-Gastroenterology 47 419-423. 

Buzdar AU, Ibrahim NK, brands D, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paditaxel, and epimbidn chemotherapy Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 2005, 23 (published ahead of print). 

Fattorossi A et al. Neoadjuvant therapy changes the lymphocyte composition of tumordraining lymph nodes in cervical carcinoma. Cancer 2004 100 1418-1428. 

Arnould L, Arveux P, Couturier J, et al (2007) Pathologic complete response to trastuzumab-based neoadjuvant therapy is related to the level of HER-2 amplification. Clin Cancer Res 13 6404-6409... 

Gruenberger B, Tamandl D, Schueller J, Scheithauer W, Zielinski C, Herbst F, Gruenberger T. Bevacizumab, capecita-bine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol 2008 26(11) 1830-5. 

Dene Simpson, Greg L. Plosker, Paclitaxel As Adjuvant or Neoadjuvant Therapy in Early Breast Cancer, Drugs 64 (2004), p. 1839-1847. 

Neoadjuvant chemotherapy is appropriate for patients with locally advanced or inflammatory breast cancer, followed by local therapy and further adjuvant systemic therapy. 

The use of preoperative systemic therapy is gaining favor in both early-stage and locally advanced breast cancers. This approach to therapy, referred to as neoadjuvant or primary systemic therapy, most often consists of chemotherapy but in special circumstances also may include hormonal therapy (e.g., in inoperable patients with significant comorbidities). The advantages of preoperative systemic therapy include... 

Bonomi P, Faber LP. Neoadjuvant chemoradiation therapy in non-small cell lung cancer The RusUniversity experience. Lung Cancer 1993 9 383-390. 

EnzingerP, Ilson D, Minsky BD, etal. Neoadjuvant Concurrent 96 HourTaxol, Cisplatin, and Radiation Therapy Promising Toxicity Profile and Response in localized Esophageal Cancer. Am Soc Clin Oncol 1999 18 271a. 

There are several possible reasons for the negative results of this trial. One possibility is that an insufficient amount of chemotherapy was administered. Few would argue that two cycles of chemotherapy is likely insufficient to eradicate microscopic metastatic disease. However, in a 975 patient trial conducted by the Medical Research Council and the European Organization for the Research and Treatment of Cancer, three cycles of CMV given prior to definitive therapy failed to provide the 10% improvement in survival that could have been detected by the trial (43). Similarly, other trials of neoadjuvant chemotherapy to date have similarly not shown any obvious improvement in survival (70-739, so it is unlikely that the number of cycles of therapy here had a significant impact on the outcome of the study. Even if more cycles could have had an impact, it should be remembered that this trial was stopped early because of chemotherapy-related treatment deaths with only two cycles of treatment. Others... 

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