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... 

Neoadjuvant therapy is administered before surgery to shrink the tumor, thereby making it resectable. Neoadjuvant RT may also prevent local recurrence. 

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. 

Postoperative Radiation Therapy Postoperative Chemotherapy or Chemoradiation NeOADJUVANT THERAPY, In GENERAL Preoperative Radiation Therapy Preoperative Chemotherapy Preoperative Chemoradiation... 

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. 

The introduction of neoadjuvant therapy prior to surgical resection has made pretreatment clinical staging an important aspect of care. The goal of staging is to determine the TNM status of the patient using the current American Joint Commission Staging System (Table 1). 

With a median follow-up of 8.2 yr, neoadjuvant therapy did not improve survival over surgery alone. Median survival was 17.6 vs 16.9 mo. Three-year survival was 16% for surgery only vs 30% for preoperative chemoradiation (p = 0.15). Multivariate analysis showed a survival benefit to neoadjuvant therapy (p = 0.09). There was also a significant... 

The neoadjuvant therapy was well tolerated with only a 15% incidence of grade 3 toxicity. Operative mortality was comparable between the two groups (9% vs 4%). With a median follow up of 18 mo, there was a significant improvement in median survival (16 vs 11 mo,p = 0.01) and 3-yr survival (32 vs 6%,p = 0.01) (35). 

Hoff SJ, Stewart JR, Sawyers JL, et al. Preliminary results with neoadjuvant therapy and resection for esophageal carcinoma. Ann Thorac Surg 1993 56(2) 282-286. 

Stewart JR, Hoff SJ, Johnson DH, et al. Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. Ann Surg 1993 218(4) 571—576. 

The metabolic effects of a neoadjuvant chemotherapy/radiochemotherapy can be assessed during and after treatment. Evaluation late in the course of treatment and after completion of treatment may predict survival and may be associated with the amount of residual viable tumor cells and histopathologic tumor response. However, the therapeutic relevance of this prognostic information is limited, as it is obtained too late for alteration of therapeutic strategy. Therefore, it is considered important to differentiate between response and nonresponse early in the course of neoadjuvant therapy. 

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). 

One study showed 43% ErbB-2 positivity in esophageal tumors, and association with a better prognosis to neoadjuvant therapy (Duhaylongsod et al., 1995). In Barrett s adenocarcinoma expression correlates with decreased patient survival (Flejou et al., 1994). 

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