Key Points
➤ Multiple studies of both chemotherapy and endocrine therapy have shown
that neoadjuvant treatment can increase the likelihood of breast-conserving
surgery.
➤ The CTNeoBC pooled analysis of neoadjuvant breast cancer clinical trials
published in 2014 confirmed that achievement of a pathologic complete
response (pCR) with neoadjuvant treatment was prognostic.
• It also showed that the association between pCR and outcomes was strongest in
patients with triple negative and human epidermal growth factor receptor 2 (HER2)-
positive disease.
➤ Optimal therapy for breast cancer is driven by subtype.
Treatment
Candidates
➤ Neoadjuvant chemotherapy is the treatment of choice for patients with
inflammatory breast cancer (IBC) or those with unresectable/locally
advanced disease at presentation whose disease may be rendered
resectable with neoadjuvant treatment. (Strong Recommendation; IC-L)
➤ Tumor histology, grade, stage and estrogen, progesterone, and HER2
expression should routinely be used to guide clinical decisions as to
whether or not to pursue neoadjuvant chemotherapy. There is insufficient
evidence to support the use of other immunochemical markers,
morphological markers (e.g., tumor infiltrating lymphocytes or TILs) or
genomic profiles to guide a clinical decision as to whether or not to pursue
neoadjuvant chemotherapy. (Moderate Recommendation; IC-Ins)
➤ Neoadjuvant systemic therapy should be offered to patients with high-risk
HER2+ or triple negative breast cancer (TNBC) in whom the finding of
residual disease would guide recommendations related to adjuvant therapy.
(Strong recommendation; EB-B-H)
