Adjuvant Therapy for Breast Cancer: A Brief Overview of the NSABP Experience and Some Thoughts on Neoadjuvant Chemotherapy

Abstract

When the first trials evaluating postoperative adjuvant therapy for the treatment of primary breast cancer were being designed in the early 1970s, it was considered a prerequisite that the drugs employed be those which proved to be of benefit in patients with advanced disease. Similarly, when embarking upon trials to evaluate the concept of neoadjuvant therapy (preoperative) it seems entirely appropriate that the therapies considered for use be those which have demonstrated an advantage when used postoperatively. In fact, the question still remains in the minds of many as to whether postoperative adjuvant chemotherapy has resulted in a benefit and, if so, in what patients. Of course, there remains the possibility, but unlikely, that nonadvantageous postoperative therapies might be beneficial in the neoadjuvant setting. Nonetheless, logic would dictate that as a starting point regimens of proven worth be employed.