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Preoperative Systemic Therapy for Operable Breast Cancer

  • Yesim Eralp
Chapter

Abstract

Preoperative systemic chemotherapy (PSC), also known as “neoadjuvant chemotherapy”, is an important therapy option that can be considered for most patients with breast cancer. PSC has evolved into an integral part of the multidisciplinary treatment approach for breast cancer and has a long history that spans nearly four decades. Despite previous beliefs that it is more suitable for locally advanced or inflammatory disease, PSC is increasingly popular in the breast oncology community for treating patients with earlier stages. As safe and as effective as adjuvant chemotherapy, this approach not only has the advantage of facilitating breast-conserving surgery for patients in whom an optimal cosmetic outcome with upfront surgery is not possible but also has potential for better drug delivery to the tumor site with an intact vasculature before any local intervention. Furthermore, PSC provides an ideal setting for observing the responsiveness to a given treatment as well as relevant information on the biology of the tumor by enabling biomarker analysis. It is also anticipated that accumulating data on the strong association of survival with pathologic complete response may lead to a change the regulatory requirements for drug approval, which may eventually reduce the need for costly and time-consuming large adjuvant trials. In conclusion, preoperative systemic chemotherapy is both 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.

Keywords

Preoperative chemotherapy Predictive biomarkers Trastuzumab Pertuzumab Everolimus Bevacisumab Predictive biomarkers 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yesim Eralp
    • 1
  1. 1.Internal Medicine, Medical Oncology, Istanbul University, Institute of Oncology, Istanbul Medical Faculty, Department of Medical OncologyIstanbulTurkey

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