J.Jpn. Surg. Soc.. 122(3): 325-329, 2021

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Feature topic

CURRENT STATUS AND FUTURE DIRECTION OF NEOADJUVANT THERAPY FOR EARLY BREAST CANCER

Neoadjuvant therapies for breast cancer have been administered to patients with locally advanced disease or without indications for breast-conserving surgery in order to achieve tumor shrinkage. In addition, since the efficacy of neoadjuvant therapy predicts the outcome for each patient, it potentiates personalized medicine. The prognosis of patients with triple-negative (TN) for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), and HER2-positive breast cancers who do not achieve a pathological complete response (pCR) is poor, but additional treatment with capecitabine for TN and T-DM1 for HER2-positive breast cancers significantly improves their prognosis. For hormone receptor (HR)-positive/HER2-negative breast cancers, neoadjuvant endocrine therapy showed response rates similar to those after breast-conserving surgery as compared with neoadjuvant chemotherapy. Instead of pCR, the reduction of Ki67 expression levels is used as a surrogate prognostic indicator for neoadjuvant endocrine therapy. The combination of immune checkpoint inhibitors with chemotherapy for TN breast cancers, and CDK4/6 inhibitors with endocrine therapy for HR-positive/HER2-negative breast cancers, may be introduced in clinical practice in the future.

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