Neoadjuvant Therapy for Breast Cancer

Standard of care foe bulky breast or axillary disease:
- primary tumor 2-5cm
- <2cm but metastatic axillary LNs

Early skeptisism for this approach is unfounded: concern initially that pts would have poorer operative outcomes due to wound complications

McCready and Colleagues:
- ALN retains prognostic value after neoadjuvant Rx
- Not clear if neoadjuvant Rx impacts survival (but it's at least equivalent overall survival)
- 80% of pts have ~50% shriknage of tumor
- only 2-3% have signs of progression during neoadjuvant Rx

If there is complete pathologic regression there is a survival benefit

NSABP B-18:
- 4 cycles of doxorubicin and cyclophosphamide
- 5 year survival of complete response pts ~50%
- however, only 12% of pts achieve this kind of response

Advantages:
- Down size tumor in 80% of pts
- Determine which are chemo-responsive