Neoadjuvant Therapy for Breast Cancer

Neoadjuvant therapy of early breast cancer consists of systemic therapy (chemotherapy, endocrine, or biologic therapy) administered prior to definitive surgery. This approach is suited to certain well-defined patient groups. Studies have not shown improvements in the outcomes of disease-free or overall survival for neoadjuvant therapy compared to conventional adjuvant therapy, and it should not be selected with this intent. We review the criteria for considering neoadjuvant therapy, and discuss the key literature regarding efficacy, response evaluation, optimal duration, and sequence of neoadjuvant therapy. We discuss management dilemmas related to the use of neoadjuvant therapy, including the surgical management of the axilla and the use of postmastectomy radiation. Data regarding specific neoadjuvant strategies are reviewed, including cytotoxic, HER2-directed, and endocrine approaches.