open access

Vol 71, No 1 (2021)
Review paper
Published online: 2021-02-05
Get Citation

Neoadjuvant therapy for breast cancer patients and its impact on surgical treatment and radiotherapy (part 1.)

Zbigniew I. Nowecki, Agnieszka Jagiełło-Gruszfeld, Katarzyna Pogoda, Anna Niwińska, Wojciech P. Olszewski, Paweł Winter, Rafał Matkowski, Wojciech M. Wysocki
DOI: 10.5603/NJO.2021.0004
·
Nowotwory. Journal of Oncology 2021;71(1):17-25.

open access

Vol 71, No 1 (2021)
Review article
Published online: 2021-02-05

Abstract

Neoadjuvant therapy (NAT) is increasingly applied in patients with initially inoperable breast cancers and, frequently, in those with tumours that are initially operable, too. In most cases, the response to the applied NAT affects the scope of surgical treatment and radiotherapy, and in some situations also the complementary systemic postoperative treatment. The available studies indicate importance of response to NAT within the breast and regional lymph nodes. Assessment of response to treatment allows personalization of treatment and in some cases a change of therapy, which improves long-term outcomes.

This article summarizes the current rules of conduct in patients with early breast cancer qualified for neoadjuvant thera­py, paying attention to the practical aspects and possibilities of national health insurance-covered therapies in Poland. It discusses in detail the applied regimens of systemic therapy, surgical techniques, eligibility rules and complementary radiotherapy. Systems for assessing response to neoadjuvant treatment are also presented.

Abstract

Neoadjuvant therapy (NAT) is increasingly applied in patients with initially inoperable breast cancers and, frequently, in those with tumours that are initially operable, too. In most cases, the response to the applied NAT affects the scope of surgical treatment and radiotherapy, and in some situations also the complementary systemic postoperative treatment. The available studies indicate importance of response to NAT within the breast and regional lymph nodes. Assessment of response to treatment allows personalization of treatment and in some cases a change of therapy, which improves long-term outcomes.

This article summarizes the current rules of conduct in patients with early breast cancer qualified for neoadjuvant thera­py, paying attention to the practical aspects and possibilities of national health insurance-covered therapies in Poland. It discusses in detail the applied regimens of systemic therapy, surgical techniques, eligibility rules and complementary radiotherapy. Systems for assessing response to neoadjuvant treatment are also presented.

Get Citation

Keywords

breast cancer; surgery; systemic therapy; neoadjuvant therapy; adjuvant therapy

About this article
Title

Neoadjuvant therapy for breast cancer patients and its impact on surgical treatment and radiotherapy (part 1.)

Journal

Nowotwory. Journal of Oncology

Issue

Vol 71, No 1 (2021)

Article type

Review paper

Pages

17-25

Published online

2021-02-05

DOI

10.5603/NJO.2021.0004

Bibliographic record

Nowotwory. Journal of Oncology 2021;71(1):17-25.

Keywords

breast cancer
surgery
systemic therapy
neoadjuvant therapy
adjuvant therapy

Authors

Zbigniew I. Nowecki
Agnieszka Jagiełło-Gruszfeld
Katarzyna Pogoda
Anna Niwińska
Wojciech P. Olszewski
Paweł Winter
Rafał Matkowski
Wojciech M. Wysocki

References (28)
  1. Gallagher KK, Ollila DW. Indications for Neoadjuvant Systemic Therapy for Breast Cancer. Adv Surg. 2019; 53: 271–292.
  2. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018; 19(1): 27–39.
  3. AGO e. V.in der DGGG e.V. sowie in der DKG e.V. Guidelines Breast Version 2020.1 2020. https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2020/PDF_EN/2020E 12_Neoadjuvant %28Primary%29 Systemic Therapy.pdf (19.07.2020).
  4. Nowecki Z, Jeziorski A. Chirurgiczne leczenie zmian nowotworowych piersi II Konsensus Polskiego Towarzystwa Chirurgii Onkologicznej. Bibl. Chir. Onkol. Tom 5. Via Medica, Gdańsk 2019.
  5. Racz JM, Caudle AS. Sentinel Node Lymph Node Surgery After Neoadjuvant Therapy: Principles and Techniques. Ann Surg Oncol. 2019; 26(10): 3040–3045.
  6. Chang JM, Leung JWT, Moy L, et al. Axillary Nodal Evaluation in Breast Cancer: State of the Art. Radiology. 2020; 295(3): 500–515.
  7. Kane G, Fleming C, Heneghan H, et al. False-negative rate of ultrasound-guided fine-needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients. Breast J. 2019; 25(5): 848–852.
  8. Simons JM, van Nijnatten TJA, van der Pol CC, et al. Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg. 2019; 269(3): 432–442.
  9. Cardoso F, Kyriakides S, Ohno S, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019; 30(8): 1194–1220.
  10. Burstein HJ, Curigliano G, Loibl S, et al. Members of the St. Gallen International Consensus Panel on the Primary Therapy of Early Breast Cancer 2019. Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Ann Oncol. 2019; 30(10): 1541–1557.
  11. Curigliano G, Burstein HJ, Winer EP, et al. St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol. 2017; 28(8): 1700–1712.
  12. Coates AS, Winer EP, Goldhirsch A, et al. Panel Members. Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015; 26(8): 1533–1546.
  13. Wuerstlein R, Harbeck N. Neoadjuvant Therapy for HER2-positive Breast Cancer. Rev Recent Clin Trials. 2017; 12(2): 81–92.
  14. Program lekowy styczeń 2020. Leczenie raka piersi. Załącznik B.9. https://www.gov.pl/web/zdrowie/choroby-onkologiczne (6.07.2020).
  15. Puglisi F, Fontanella C, Amoroso V, et al. Current challenges in HER2-positive breast cancer. Crit Rev Oncol Hematol. 2016; 98: 211–221.
  16. Jagiello-Gruszfeld A, Pogoda K, Niwinska A, et al. Are anthracyclines needed for the neoadjuvant treatment of patients with HER2-positive early breast cancer? J Clin Oncol. 2018; 36(15_suppl): e12599–e12599.
  17. Jagiello-Gruszfeld A, Lemanska I, Sienkiewicz R, et al. Pathological outcomes of HER2-positive early breast cancer patients treated with neoadjuvant trastuzumab or dual anti-HER2 therapy and carboplatin with docetaxel: A Maria Sklodowska-Curie National Research Institute of Oncology experience. J Clin Oncol. 2020; 38(15_suppl): e12655–e12655.
  18. 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): 164–172.
  19. von Minckwitz G, Huang CS, Mano MS, et al. KATHERINE Investigators. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med. 2019; 380(7): 617–628.
  20. Masuda N, Lee SJ, Ohtani S, et al. Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med. 2017; 376(22): 2147–2159.
  21. Müller C, Juhasz-Böss I, Schmidt G, et al. Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients. Arch Gynecol Obstet. 2020; 301(4): 1055–1059.
  22. Adamson K, Chavez-MacGregor M, Caudle A, et al. Neoadjuvant Chemotherapy does not Increase Complications in Oncoplastic Breast-Conserving Surgery. Ann Surg Oncol. 2019; 26(9): 2730–2737.
  23. Omarini C, Guaitoli G, Noventa S, et al. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol. 2017; 43(4): 613–618.
  24. Macdonald S, Oncology R, General M. Breast Cancer. J R Soc Med. 2016; 70: 515–517.
  25. Ahmed SH. Safety of neoadjuvant chemotherapy for the treatment of breast cancer. Expert Opin Drug Saf. 2019; 18(9): 817–827.
  26. Weber JJ, Jochelson MS, Eaton A, et al. MRI and Prediction of Pathologic Complete Response in the Breast and Axilla after Neoadjuvant Chemotherapy for Breast Cancer. J Am Coll Surg. 2017; 225(6): 740–746.
  27. Di Micco R, Zuber V, Fiacco E, et al. Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype. Eur J Surg Oncol. 2019; 45(6): 969–975.
  28. Barrio AV, Mamtani A, Edelweiss M, et al. How Often Is Treatment Effect Identified in Axillary Nodes with a Pathologic Complete Response After Neoadjuvant Chemotherapy? Ann Surg Oncol. 2016; 23(11): 3475–3480.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest VM Media sp. z o.o. VM Group sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl