Preoperative Chemotherapy for Operable Breast Cancer

  • Eleftherios P. Mamounas
  • Bernard Fisher
Part of the Cancer Treatment and Research book series (CTAR, volume 103)


During the past 25 years, there has been a significant change in the way in which operable breast cancer is managed. As a result of laboratory and clinical investigations conducted during the 1960s, evidence was obtained that challenged Halstedian principles of tumor dissemination and provided support for an alternative hypothesis.1 Findings from subsequent randomized clinical trials demonstrated that the extent of surgical resection had no effect on the patient’s outcome2 and that the administration of systemic therapy after surgery significantly improved the disease-free survival (DFS) and survival of such patients.3 Consequently, there was a shift in emphasis away from surgery as the sole treatment for breast cancer, and systemic therapy became an integral part of the management of the disease.


Breast Cancer Fine Needle Aspiration Preoperative Chemotherapy Pathologic Complete Response Postoperative Chemotherapy 
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  1. 1.
    Fisher B: Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky Memorial Lecture. Cancer Res; 40: 3863–3874, 1980.PubMedGoogle Scholar
  2. 2.
    Early Breast Cancer Trialists’ Collaborative Group: Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Eng J Med; 333: 1444–1455, 1995.CrossRefGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group: Systemic treatment of early breast cancer by hormonal, cytoxic, or immune therapy: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Lancet; 339:1–15 (Part 1 ), 71–85 (Part 2), 1992.Google Scholar
  4. 4.
    Skipper HE: Kinetics of mammary tumor cell growth and implications for therapy. Cancer; 28: 1479–1499, 1971.PubMedCrossRefGoogle Scholar
  5. 5.
    Goldie JH and Coldman AJ: A mathematical model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep; 63: 1727–1733, 1979.PubMedGoogle Scholar
  6. 6.
    Gunduz N, Fisher B, Saffer EA: Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res; 39: 3861–3865, 1979.PubMedGoogle Scholar
  7. 7.
    Fisher B, Gunduz N, and Saffer EA: Influence of the interval between primary tumor removal and chemotherapy of kinetics and growth of metastases. Cancer Res; 43: 1488–1492, 1983.PubMedGoogle Scholar
  8. 8.
    Rosen G: Preoperative chemotherapy for osteogenic sarcoma. Cancer; 49: 1221–1230, 1982.PubMedCrossRefGoogle Scholar
  9. 9.
    Schuller DE: Preoperative reductive chemotherapy for locally advanced carcinoma of the oral activity, oropharynx, and hypopharynx. Cancer; 51: 15–19, 1983.PubMedCrossRefGoogle Scholar
  10. 10.
    Leichman L, Steiger Z, Seydel HG, et al: Preoperative chemotherapy and radiation therapy for patients with cancer of the esophagus: a potentially curative approach. J Clin Oncol; 2: 75–79, 1984.PubMedGoogle Scholar
  11. 11.
    Perloff M, Lesnick J: Chemotherapy before and after mastectomy in Stage III breast cancer. Arch Surg; 117: 879–881, 1982.PubMedCrossRefGoogle Scholar
  12. 12.
    Schick P, Goodstein J, Moor J, et al: Preoperative chemotherapy followed by mastectomy for locally advanced breast cancer. J Surg Oncol; 22: 278282, 1983.Google Scholar
  13. 13.
    Sorace RA, Bagley CS, Lichter AS, et al: The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery. World J Surg; 9: 775–785, 1985.PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher B, Redmond C, Poisson R, et al: Eight-year results of a randomized clinical trial comparing mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med; 320: 820–828, 1989.Google Scholar
  15. 15.
    Fisher B, Anderson S, Redmond C, et al: Reanalysis and results after 12-year follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med; 333: 1456–1461, 1995.PubMedCrossRefGoogle Scholar
  16. 16.
    Jacquillat C, Weil M, Baillet F, et al: Results of neoadjuvant chemotherapy and radiation therapy in breast conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer; 66: 119–129, 1990.PubMedCrossRefGoogle Scholar
  17. 17.
    Bonadonna G, Veronesi U, Brambilla C, et al: Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst; 82: 1539–1545, 1990.PubMedCrossRefGoogle Scholar
  18. 18.
    Tubiana-Hulin M, Malek M, Briffod M, et al: Preoperative chemotherapy of operable breast cancer (stage IIIA). Prognostic factors of distant recurrence. Eur J Cancer; Vol. 29A, Suppl. 6: S76 0391 ), 1993.Google Scholar
  19. 19.
    Belembaogo E, Feillel V, Chollet P, et al: Neoadjuvant chemotherapy in 126 operable breast cancers. Eur J Cancer; Vol. 28A, 4 /5: 896–900, 1992.CrossRefGoogle Scholar
  20. 20.
    Smith IE, Jones AL, O’Brien MER, et al: Primary medical (neo-adjuvant) chemotherapy for operable breast cancer. Eur J Cancer; Vol. 29A, 12: 17961799, 1993.Google Scholar
  21. 21.
    Mauriac L, Durand M, Avril A, Dilhuydy J-M: Effects on primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Ann Oncol; 2: 347–354, 1991.PubMedGoogle Scholar
  22. 22.
    Scholl SM, Fourquet A, Asselain B, et al: Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomized trial: S6. Eur J Cancer; 30: 645–652, 1994.CrossRefGoogle Scholar
  23. 23.
    Powles TJ, Hickish TF, Makris A, et al: Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol; 13: 547–552, 1995.PubMedGoogle Scholar
  24. 24.
    Fisher B, Brown A, Mamounas E, et al: Effect of preoperative chemotherapy of local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol; 15: 2483–2493, 1997.PubMedGoogle Scholar
  25. 25.
    Fisher B, Rockette H, Robidoux A, et al: Effect of preoperative therapy for breast cancer (BC) on local-regional disease: First report of NSABP B-18. Proc Am Soc Clin Oncol; 13: 64, 1994.Google Scholar
  26. 26.
    Fisher B, Bryant J, Wolmark N, et al: Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol; 16: 2672–2685, 1998.PubMedGoogle Scholar
  27. 27.
    Fisher B, Mamounas EP: Preoperative chemotherapy: a model for studying the biology and therapy of primary breast cancer. J Clin Oncol; 13: 537–540, 1995.PubMedGoogle Scholar
  28. 28.
    Fisher B, Dignam J, Wolmark N, et al: Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer. J Natl Cancer Inst; 89: 1673–1682, 1997.PubMedCrossRefGoogle Scholar
  29. 29.
    Mamounas EP: NSABP Protocol B-27: preoperative doxorubicin plus cyclophosphamide followed by preoperative or postoperative docetaxel. Oncology; Suppl. 6: 37–40, 1997.Google Scholar
  30. 30.
    Mamounas EP: Overview of National Surgical Adjuvant Breast Project neoadjuvant chemotherapy studies. Semin Oncol; 25 (Suppl 3): 31–35, 1998.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Eleftherios P. Mamounas
    • 1
  • Bernard Fisher
    • 2
  1. 1.Case Western Reserve UniversityUSA
  2. 2.University of PittsburghUSA

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