ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

NEOADJUVANT SYSTEMIC THERAPY

Anıl Yıldız

Medipol Mega University Hospital, Department of Oncology, İstanbul, Türkiye

Yıldız A. Neoadjuvant Systemic Therapy. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.65-77.

ABSTRACT

Neoadjuvant systemic therapy (NST) is a key approach in breast cancer management, especially for patients with locally advanced or high-risk subtypes. Its main goals are to shrink tumors before surgery, increase the chances of breast-conserving surgery, and provide valuable prognostic information based on how the tumor responds to treatment. NST is recommended for patients with inoperable or locally advanced breast cancer, such as those with inflammatory disease or extensive lymph node involvement. It is also used in operable cases where reducing tumor size can help achieve breast conservation, particularly in triple-negative and HER2-positive cancers. Patient selection is based on clinical stage, tumor biology (ER, PR, HER2 status), and individual factors. NST includes chemotherapy, endocrine therapy, and targeted agents. For hormone receptor-positive, HER2-negative cancers, both chemotherapy and endocrine therapy are options, with endocrine therapy preferred in postmenopausal women or those with low-risk tumors. In HER2-positive disease, NST combines chemotherapy with anti-HER2 agents (trastuzumab, pertuzumab), with anthracycline-free regimens often favored for lower toxicity and similar efficacy. For triple-negative breast cancer, anthracyclineand taxane-based regimens are standard, with carboplatin and immunotherapy (e.g., pembrolizumab) further improving response rates. NST aims to reduce tumor burden, enable less extensive surgery, and assess tumor sensitivity to therapy. Achieving a pathologic complete response (pCR) is linked to better survival, especially in HER2-positive and triple-negative subtypes. NST also allows for real-time assessment of treatment effectiveness, guiding further therapy decisions. Accurate evaluation of residual disease after NST is crucial for surgical planning. Dynamic contrast-enhanced MRI is the most accurate imaging method for assessing response and predicting residual tumor size. NST should be managed by a multidisciplinary team to optimize outcomes and manage side effects. Regimen choice is tailored to tumor subtype, patient comorbidities, and preferences, balancing efficacy and safety. Neoadjuvant systemic therapy is integral to modern breast cancer care, offering equivalent survival to adjuvant therapy while improving surgical options and providing important prognostic information. Its use is tailored to tumor biology and patient characteristics, with ongoing research refining optimal regimens and expanding indications.

Keywords: Neoadjuvant therapy; Breast neoplasms; Molecular targeted therapy; Pathologic complete response; Immunotherapy

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