Info
Which patients with breast cancer are appropriate candidates for neoadjuvant systemic therapy
Recommendation 1.1. Neoadjuvant chemotherapy is the treatment of choice for patients with inflammatory breast cancer or those with unresectable or locally advanced disease at presentation whose disease may be rendered resectable with neoadjuvant treatment (Type: informal consensus; Evidence quality: low; Strength of recommendation: strong). Recommendation 1.2. Tumor histology, grade, stage and estrogen, progesterone, and HER2 expression should routinely be used to guide clinical decisions as to whether or not to pursue neoadjuvant chemotherapy. There is insufficient evidence to support the use of other immunochemical markers, morphological markers (eg, tumor-infiltrating lymphocytes) or genomic profiles to guide a clinical decision as to whether or not to pursue neoadjuvant chemotherapy (Type: informal consensus; Evidence quality: insufficient; Strength of recommendation: moderate). Recommendation 1.3. Neoadjuvant systemic therapy should be offered to patients with high-risk HER2-positive or triple-negative breast cancer (TNBC) in whom the finding of residual disease would guide recommendations related to adjuvant therapy (Type: evidence-based; benefits outweigh harms; Evidence quality: high; Strength of recommendation: strong). Recommendation 1.4. Neoadjuvant systemic therapy may be offered to reduce the extent of surgery (breast-conserving surgery and axillary lymph node dissection). Chemotherapy with or without targeted therapy, or endocrine therapy (if hormone receptor-positive [HR-positive]) may be offered (Type: evidence-based; benefits outweigh harms; Evidence quality: intermediate; Strength of recommendation: moderate). Recommendation 1.5. In patients for whom a delay in surgery is preferable (eg, for genetic testing required for surgical treatment decision making, to allow time to consider reconstructive options) or unavoidable, neoadjuvant systemic therapy may be offered (Type: informal consensus; benefits outweigh harms; Evidence quality: low; Strength of recommendation: moderate).
Siblings
- Which patients with breast cancer are appropriate candidates for neoadjuvant systemic therapy
- How should response be measured in patients receiving neoadjuvant chemotherapy
- What neoadjuvant systemic therapy regimens are recommended for patients with TNBC
- What neoadjuvant treatment is recommended for patients with HR-positive HER2-negative breast cancer
- What neoadjuvant treatment is recommended for patients with HER2-positive disease