Info
Hormone-positive disease-neoadjuvant therapy-of-localized breast cancer
Chemo: Consider for downstaging breast &/or axillary nodes for BCS & to spare ALND in inoperable or cN1 pts. ddACT preferred in this instance. Chances of pCR ∼20%, but pCR not strongly assoc w/ survival outcome Neoadj endocrine therapy (NET): Preferred regimen: AI for at least 6 mos. NET may have equal BCS rates & clinical response as combination chemo (JAMA Oncol 2016;2:1477). pCR rate: NET < NAC All AIs equal (JCO 2011;29:2342) & AI > tam (Lancet Oncol, 13:345-352) Adding CDK4/6 not rec-no clear benefit in pCR rate vs. AI alone & vs. chemo. New biomarkers under investigation (Ann Oncol 2018;29:2334-2340: summarizes results of NeoPalAna, neoMONARCH, NeoPAL trials) Premenopausal pts w/ cN1 → Chemo preferred (RxPONDER: NEJM 2021;385:2336-2347) Triple negative disease-of-localized breast cancer Stage I: pT1aN0: No chemo; pT1b/c: Discuss w/ pt; pT2: Recommend chemo Clinical Stage II-III: NAC rec for T ≥ 2 cm. Preferred regimens: ddACT, CMF or TC if anthracycline contraindicated Adding carbo to NAC ↑ pCR, independent of BRCA status, but conflicting data on DFS impact (↑ in GeparSixto, [Lancet Onc 2014;15:747]; no effect in CALGB 40603 [JCO 2014;33:13]) Addition of ICI: Remains under investigation After NAC: If pCR → observation. If nonpCR → capecitabine (cape) for 6-8 cycles (recurrence & survival benefit) (CREATEX, NEJM 2017;376:2147-2159) Pathologic stage II-III: Adj. chemo is rec (anthra & taxane-based regimens as above. CMF or TC if anthra contraindicated)
Siblings
- Local management with surgery and radiation-of-localized breast cancer
- Chemotherapy regimens for NAV or ADJ use in HR positive and TNBC-of-localized breast cancer
- Hormone positive disease-adjuvant endocrine treatment
- Hormone-positive disease-neoadjuvant therapy-of-localized breast cancer
- HER2-positive disease-of-localized breast cancer
- Considerations for young patients-of-localized breast cancer