Neoadjuvant chemotherapy for locally advanced breast cancer: A review of the literature and future directions

Abstract 

Background

Most patients with locally advanced primary breast cancer have micrometastases at the time of presentation. Randomised trials on the use of neoadjuvant chemotherapy have not been carried out specifically in a population of breast cancer patients with locally advanced disease (LAPC). Despite this, its use for cytoreduction in these patients is an established option which may facilitate excision of the primary tumour and local lymph node metastasis for local control. Significant improvements in local disease control have been seen with recent advances in systemic chemotherapy regimens although thus far this has not shown in randomised trials to translate into overall survival benefits.

Methods

In this review, all studies where a large proportion (approximately 70%) of included patients with LAPC, were selected. A search of Medline and PubMed databases was performed. Specifically, the different chemotherapy regimens and their relation to oncological outcomes was assessed.

Results and conclusion

The studies assessed were heterogeneous with regard to patient selection and chemotherapy regimens used. A complete pathological response is the strongest predictor of disease-free and overall survival. Recent studies on the use of targeted biological therapies in addition to chemotherapy suggest that rates of complete pathological response may be significantly increased when compared to chemotherapy alone. Furthermore, improvements in localisation and imaging techniques, used in conjunction with the increasing use of oncoplastic breast-conserving techniques, highlight the possibility that a subgroup of these patients may safely be treated with breast conservation.

Keywords: Locally advanced primary breast cancer, Neoadjuvant chemotherapy, Clinical response, Pathological response, Oncoplastic conservation surgery