Systemic treatment of breast cancer. New insights into neoadjuvant and adjuvant therapies

Systemic therapy in the adjuvant and neoadjuvant setting is part of the multimodal concept of breast cancer therapy. Anthracycline-based chemotherapy retains its status with preference for dose-dense regimens, and non-inferiority is demonstrated for anthracycline-free regimens, e.g., 6 cycles of docetaxel, carboplatin, and trastuzumab. The use of double anti-HER2 blockade with trastuzumab and pertuzumab plus chemotherapy demonstrated a better outcome compared to trastuzumab alone and chemotherapy for patients with poor prognosis. For de-escalation or avoidance of chemotherapy in patients with hormone receptor positive, HER2 negative breast cancer, further study data will have to be awaited after the first promising data of prognostic-predictive biomarkers such as dynamic Ki-67 and gene expression. Postneoadjuvant therapy has meanwhile become established for triple-negative and HER2-positive carcinomas without pathologic complete remission after neoadjuvant therapy. Endocrine therapy has led to a significant reduction in mortality.