Preoperative Therapy for Operable Breast Cancer

Preoperative systemic chemotherapy (PSC), also known as “neoadjuvant chemotherapy,” is an important therapy option for most patients with breast cancer. PSC has evolved as an integral part of the multidisciplinary treatment approach for breast cancer and has a long history that dates back nearly four decades. Despite previous beliefs that it is more suitable for locally advanced or inflammatory disease, PSC is becoming increasingly popular in the breast oncology community for the treatment of earlier-stage disease. As safe and effective as adjuvant chemotherapy, this approach not only has the advantage of facilitating breast-conserving surgery (BCS) for patients in whom an optimal cosmetic outcome with upfront surgery is not possible but also has the potential to improve drug delivery to the tumor site by retaining intact vasculature before any local intervention is made. Furthermore, PSC provides an ideal setting in which the responsiveness of a given treatment can be observed and provides relevant information on the biology of the tumor by enabling biomarker analysis. Accumulating data on the strong association with survival and pathological complete response (pCR) may lead to a change in the regulatory requirements for drug approval and, consequently, reduce the need for costly and time-consuming large adjuvant trials. In conclusion, PSC is a valuable research tool for identifying predictive molecular biomarkers and a valid treatment option for patients with early-stage breast cancer. However, the decision to treat a patient with neoadjuvant chemotherapy requires careful clinical judgment and multidisciplinary evaluation by an experienced team.