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Neoadjuvant Therapy for Breast Cancer: Established Concepts and Emerging Strategies

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Abstract

In the last decade, the systemic treatment approach for patients with early breast cancer has partly shifted from adjuvant treatment to neoadjuvant treatment. Systemic treatment administration started as a ‘one size fits all’ approach but is currently customized according to each breast cancer subtype. Systemic treatment in a neoadjuvant setting is at least as effective as in an adjuvant setting and has several additional advantages. First, it enables response monitoring and provides prognostic information; second, it downstages the tumor, allowing for less extensive surgery, improved cosmetic outcomes, and reduced postoperative complications such as lymphedema; and third, it enables early development of new treatment strategies by using pathological complete remission as a surrogate outcome of event-free and overall survival. In this review we give an overview of the current standard of neoadjuvant systemic treatment strategies for the three main subtypes of breast cancer: hormone receptor-positive, triple-negative, and human epidermal growth factor receptor 2-positive. Additionally, we summarize drugs that are under investigation for use in the neoadjuvant setting.

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Fig. 1

Adapted with permission from Macmillan Publishers Ltd. [273]. Copyright (2015)

Fig. 2

Adapted with permission from Macmillan Publishers Ltd. [274]. Copyright (2014)

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Authors and Affiliations

  1. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    Tessa G. Steenbruggen, Mette S. van Ramshorst, Marleen Kok, Sabine C. Linn, Carolien H. Smorenburg & Gabe S. Sonke

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  1. Tessa G. Steenbruggen
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  2. Mette S. van Ramshorst
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  3. Marleen Kok
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  4. Sabine C. Linn
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  5. Carolien H. Smorenburg
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  6. Gabe S. Sonke
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Corresponding author

Correspondence to Gabe S. Sonke.

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Funding

The authors thank the Dutch Cancer Society (KWF) for the fellowship grant to Marleen Kok.

Conflict of interest

Gabe S. Sonke received institutional research support funding from Roche, AstraZeneca, Merck and Novartis. Sabine C. Linn reports grants and non-financial support from AstraZeneca and Roche, grants from Genentech, advisory support (paid to the institution) from Novartis, Philips Health BV and IBM, and unpaid advisory support from Cergentis outside the submitted work. In addition, Dr. Linn has a patent pending for the BRCA-like signature (WO/2015/080585 and PCT/NL2014/050813). Marleen Kok receives an unrestricted research grant from Bristol-Myers Squibb. Tessa G. Steenbruggen, Mette S. van Ramshorst and Carolien H. Smorenburg declare that they have no competing interests.

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Steenbruggen, T.G., van Ramshorst, M.S., Kok, M. et al. Neoadjuvant Therapy for Breast Cancer: Established Concepts and Emerging Strategies. Drugs 77, 1313–1336 (2017). https://doi.org/10.1007/s40265-017-0774-5

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