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Neoadjuvant treatment in solid tumors—the earlier, the better in breast cancer

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Summary

Systemic treatment is an essential part of medical care in patients with early breast cancer. Breast cancer subtypes differ in biological features and therefore require different therapeutic approaches: in triple-negative and HER2-positive breast cancers, neoadjuvant systemic treatment is standard of care. While taxane- and anthracycline-based chemotherapy is well established in triple-negative breast cancer, the addition of immune checkpoint inhibitors based on recent studies is becoming the new standard. In HER2-positive breast cancer, there is clear evidence for the use of neoadjuvant chemotherapy in combination with the HER2-antibodies trastuzumab and pertuzumab. In luminal cancers, neoadjuvant treatment is focused on downsizing to improve breast-conserving surgery. Besides chemotherapy, neoadjuvant endocrine therapy is another option in these usually endocrine-sensitive tumors. The review summarizes the rationale for neoadjuvant treatment in breast cancer and gives an overview of the current standard of care.

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References

  1. Buzdar AU, Ibrahim NK, Francis D, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2‑positive operable breast cancer. J Clin Oncol. 2005;23:3676–85. https://doi.org/10.1200/jco.2005.07.032.

    Article  CAS  PubMed  Google Scholar 

  2. Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010;375:377–84. https://doi.org/10.1016/s0140-6736(09)61964-4.

    Article  CAS  PubMed  Google Scholar 

  3. Untch M, Loibl S, Bischoff J, et al. Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase III trial. Lancet Oncol. 2012;13:135–44. https://doi.org/10.1016/s1470-2045(11)70397-7.

    Article  CAS  PubMed  Google Scholar 

  4. Baselga J, Bradbury I, Eidtmann H, et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase III trial. Lancet. 2012;379:633–40. https://doi.org/10.1016/s0140-6736(11)61847-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gianni L, Pienkowski T, Im YH, et al. 5‑year analysis of neoadjuvant pertuzumab and trastuzumab in patients with locally advanced, inflammatory, or early-stage HER2-positive breast cancer (NeoSphere): a multicentre, open-label, phase II randomised trial. Lancet Oncol. 2016;17:791–800. https://doi.org/10.1016/s1470-2045(16)00163-7.

    Article  CAS  PubMed  Google Scholar 

  6. Schneeweiss A, Chia S, Hickish T, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013;24:2278–84. https://doi.org/10.1093/annonc/mdt182.

    Article  CAS  PubMed  Google Scholar 

  7. Schneeweiss A, Chia S, Hickish T, et al. Long-term efficacy analysis of the randomised, phase II TRYPHAENA cardiac safety study: Evaluating pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer. Eur J Cancer. 2018;89:2735. https://doi.org/10.1016/j.ejca.2017.10.021.

    Article  CAS  Google Scholar 

  8. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380:617–28. https://doi.org/10.1056/NEJMoa1814017.

    Article  Google Scholar 

  9. Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72. https://doi.org/10.1016/S0140-6736(13)62422-8.

    Article  PubMed  Google Scholar 

  10. Gerber B, Loibl S, Eidtmann H, et al. Neoadjuvant bevacizumab and anthracycline-taxane-based chemotherapy in 678 triple-negative primary breast cancers; results from the geparquinto study (GBG 44). Ann Oncol. 2013;24:2978–84. https://doi.org/10.1093/annonc/mdt361.

    Article  CAS  PubMed  Google Scholar 

  11. Sikov WM, Berry DA, Perou CM, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dosedense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance). J Clin Oncol. 2015;33:13–21. https://doi.org/10.1200/jco.2014.57.0572.

    Article  CAS  PubMed  Google Scholar 

  12. Sheperd J, Ballman K, Polley M, et al. CALGB 40603 (alliance): long-term outcomes and genomic correlates of response and survival after neoadjuvant chemotherapy with or without Carboplatin and Bevacizumab in triple-negative breast cancer. J Clin Oncol. 2022;40(12):1323–34. https://doi.org/10.1200/JCO.21.01506.

    Article  CAS  Google Scholar 

  13. von Minckwitz G, Schneeweiss A, Loibl S, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase II trial. Lancet Oncol. 2014;15:747–56. https://doi.org/10.1016/s1470-2045(14)70160-3.

    Article  Google Scholar 

  14. Loibl S, O’Shaughnessy J, Untch M, et al. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase III trial. Lancet Oncol. 2018;19:497–509. https://doi.org/10.1016/s1470-2045(18)30111-6.

    Article  CAS  PubMed  Google Scholar 

  15. Schmid P, Cortes J, Pusztai L, et al. Pembrolizumab for early triple-negative breast cancer. N Engl J Med. 2020;382:810–21. https://doi.org/10.1056/NEJMoa1910549.

    Article  CAS  PubMed  Google Scholar 

  16. Schmid P, Cortes J, Dent R, et al. Event-free survival with pembrolizumab in early triple-negative breast cancer. N Engl J Med. 2022;386:556–67. https://doi.org/10.1056/NEJMoa2112651.

    Article  CAS  PubMed  Google Scholar 

  17. Mittendorf E, Zhang H, Barrios C, et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase III trial. Lancet. 2020;396:1090–100. https://doi.org/10.1016/s0140-6736(20)31953-x.

    Article  CAS  PubMed  Google Scholar 

  18. Gianni L, Huang C, Egle D, et al. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple negative, early high-risk and locally advanced breast cancer. NeoTRIP Michelangelo randomized study. Ann Oncol. 2022;33(5):534–43. https://doi.org/10.1016/j.annonc.2022.02.004.

    Article  CAS  PubMed  Google Scholar 

  19. Loibl S, Untch M, Burchardi N, et al. A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study. Ann Oncol. 2022;33(5):534–43. https://doi.org/10.1016/j.annonc.2022.02.004.

    Article  CAS  Google Scholar 

  20. Loibl S, Schneeweiss A, Huober J, et al. Durvalumab improves long-term outcome in TNBC: results from the phase II randomized GeparNUEVO study investigating neodjuvant durvalumab in addition to an anthracycline/taxane based neoadjuvant chemotherapy in early triple-negative breast cancer (TNBC). J Clin Oncol. 2021;39(15_suppl):506. https://doi.org/10.1200/JCO.2021.39.15_SUPPL.506.

  21. Ramshort M, Voort A, Werkhoven E, et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase III trial. Lancet Oncol. 2018;19(12):1630–40. https://doi.org/10.1016/S1470-2045(18)30570-9.

    Article  Google Scholar 

  22. Harbeck N, Gluz O, Christgen M et al. Abstract S5-03: Final analysis of WSG-ADAPT HER2+/HR+ phase II trial: Efficacy, safety, and predictive markers for 12-weeks of neoadjuvant TDM1 with or without endocrine therapy versus trastuzumab+endocrine therapy in HER2-positive hormone-receptor-positive early breast cancer. DOI:10.1158/1538-7445.SABCS15-S5-03

  23. Harbeck N, Nitz U, Christgen M, et al. LBA13—Predictive impact of biomarkers on pCR and survival after de-escalated neoadjuvant T‑DM1 with or without endocrine therapy (ET) vs. trastuzumab+ET in HER2+/HR+ early breast cancer: WSG ADAPT TP trial. Ann Oncol. 2021;32(suppl_5):S1283–S346. https://doi.org/10.1016/annonc/annonc741.

    Article  Google Scholar 

  24. O’Sullivan C, Ballmann K, McCall L, et al. Alliance A011801 (compassHER2 RD): postneoadjuvant T‑DM1 + tucatinib/placebo in patients with residual HER2-positive invasive breast cancer. Future Oncol. 2021;17(34):4665–76. https://doi.org/10.2217/fon-2021-0753.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Spring L, Gupta A, Reynolds K, et al. Neoadjuvant endocrine therapy for estrogen receptor positive breast cancer A systematic review and meta-analysis. JAMA Oncol. 2016;2(11):1477–86. https://doi.org/10.1001/jamaoncol.2016.1897.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Keam B, Im S, Kim H. Prognostic impact of clinicopathologic parameters in stage II/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer. Bmc Canc. 2007;7:203.

    Article  Google Scholar 

  27. Murillo S, Cudos A, Rodriguez J, et al. Selection of neoadjuvant treatment based on the 21-GENE test results in luminal breast cancer. Breast. 2021;56:35–41. https://doi.org/10.1016/j.breast.2021.01.001.

    Article  Google Scholar 

  28. Dubsky P, Singer C, Egle D, et al. The EndoPredict score predicts response to neoadjuvant chemotherapy and neoendocrine therapy in hormone receptor-positive, human epidermal growth factor receptor 2‑negative breast cancer patients from the ABCSG-34 trial. Eur J Cancer. 2020;134:99–106. https://doi.org/10.1016/j.ejca.2020.04.020.

    Article  CAS  Google Scholar 

  29. Bear H, Anderson S, Smith R, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B‑27. J Clin Oncol. 2006;24(13):2019–27. https://doi.org/10.1200/JCO.2005.04.1665.

    Article  CAS  PubMed  Google Scholar 

  30. Rastogi P, Anderson S, Bear H, et al. Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B‑18 and B‑27. J Clin Oncol. 2008;26(5):778–85. https://doi.org/10.1200/JCO.2007.15.0235.

    Article  PubMed  Google Scholar 

  31. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B‑18. J Natl Cancer Inst Monogr. 2001; https://doi.org/10.1093/oxfordjournals.jncimonographs.a003469.

    Article  PubMed  Google Scholar 

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Correspondence to Renate Pusch.

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R. Pusch declares that she has no competing interests.

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Pusch, R. Neoadjuvant treatment in solid tumors—the earlier, the better in breast cancer. memo 15, 224–228 (2022). https://doi.org/10.1007/s12254-022-00819-4

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  • DOI: https://doi.org/10.1007/s12254-022-00819-4

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