Locally advanced breast cancer neoadjuvant chemotherapy

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... 

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. 

The goal of neoadjuvant chemotherapy in locally advanced breast cancer is cure. Complete pathologic response, determined at the time of surgery, is the desired end point. 

Honkoop AH, Luykx-de Bakker SA, Hoekman K, et al. Prolonged neoadjuvant chemotherapy with GM-CSF in locally advanced breast cancer. Oncologist 1999 4 106-111. 

Eltahir A, Heys SD, Hutcheon AW, et al. Treatment of large and locally advanced breast cancers using neoadjuvant chemotherapy. Am J Surg 1998 175 127-132. 

Sciuto R, Pasqualoni R, Bergomi S, PetrUli G, Vici P, Belli F et al. Prognostic value of (99m)Tc-sestamibi washout in predicting response of locally advanced breast cancer to neoadjuvant chemotherapy. J Nucl Med 2002 43 745-751. 

Ciarmiello A, Del Vecchio S, Silvestro P, Potena MI, Carriero MV, Thomas R et al. Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer. J Clin Oncol 1998 16 1677-1683. 

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

---