Table 2.

Summary neoadjuvant chemotherapy

Neoadjuvant chemotherapy
Results in similar disease-free survival (DFS) and overall survival (OS) as adjuvant treatment Results in similar locoregional control as adjuvant treatment Results in a higher rate of breast conserving surgery Can be offered when adjuvant chemotherapy is indicated
Predictors of response to neoadjuvant chemotherapy are negative hormone receptors, triple-negative receptors, poor grading, non-lobular histology, clinical midterm response, and young age The likelihood of a therapy response (pathologic complete response, pCR) and the long-term outcome (DFS, OS) vary in different molecular subsets pCR may only be an appropriate surrogate marker for DFS and OS in special molecular subtypes of breast cancer No invasive or non-invasive residuals in the breast and nodes (yPTO ypN0) is the best predictor for an excellent outcome and should be used as the definition of pCR
Neoadjuvant treatment necessitates a multidisciplinary approach to achieve optimal results Anthracycline/taxane-based regimens were the most effective treatments in terms of pCR and should be given over 4–6 months Anti-HER2 therapy in HER2-positive disease (currently trastuzumab outside clinical trials) should be part of the neoadjuvant treatment Other targeted approaches like bevacizumab are not standard of care and should be limited to clinical trials as long as no long-term outcome data are available