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Cancers
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Post-neoadjuvant Strategies in Breast Cancer
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Post-neoadjuvant Strategies in Breast Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 15345

Special Issue Editors

Prof. Dr. Edwin Bölke

E-Mail Website
Guest Editor
Department of Radiation Oncology, Heinrich Heine University, 40225 Dusseldorf, Germany
Interests: cancer research；mediator response；chemotherapy；radiation therapy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Tanja Fehm

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Medical Faculty and University Hospital of the Heinrich-Heine University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
Interests: minimal residual disease in breast and gynecologic cancers; CTC-based therapeutic strategies
Dr. Stefanie Corradini

E-Mail Website
Guest Editor
Department of Radiation Oncology, LMU Munich, 81377 Munich, Germany
Interests: breast cancer; radiotherapy; deep inspiration breath hold
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The post-neoadjuvant setting in early breast cancer is an attractive scenario for improving patient outcome by stratifying the adjuvant treatment according to the pathological response to the neoadjuvant systemic treatment. This strategy allows studying new systemic therapies or new combinations of treatment modalities in high-risk patients who did not achieve pathologic complete response after primary treatment.

In this context, the findings after neoadjuvant therapy can be used as an in vivo sensitivity test and further tailored treatment can improve the outcome in high-risk patients. Moreover, tailored de-escalation strategies of locoregional treatments could be another step towards reducing morbidity in patients with good response rates. To date, there is no clear evidence and there is no standard therapy routinely proposed to patients with residual disease after neoadjuvant chemotherapy, and few trials have addressed this setting. Therefore, the treatment of patients in the post-neoadjuvant setting remains a clinical challenge, with limited data supporting the use of additional adjuvant chemotherapy.

The present Special Issue of Cancers focuses on recent advances and future perspectives in the various aspects of post-neoadjuvant strategies in breast cancer patients.

Prof. Dr. Edwin Bölke
Prof. Dr. Tanja Fehm
Dr. Stefanie Corradini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chemotherapy
  • prospective trials
  • clinical investigation
  • breast tumor
  • local recurrence
  • overall survival

Published Papers (5 papers)

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Research

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14 pages, 1332 KiB  
Article
Prognoses of Patients with Hormone Receptor-Positive and Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Receiving Neoadjuvant Chemotherapy before Surgery: A Retrospective Analysis
by Shichao Zhang, Yan Liu, Xu Liu, Yingxue Liu and Jin Zhang
Cancers 2023, 15(4), 1157; https://doi.org/10.3390/cancers15041157 - 10 Feb 2023
Cited by 5 | Viewed by 1829
Abstract
Purpose: To evaluate the clinical characteristics, pathological response, and prognostic significance of hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer (BC) after neoadjuvant chemotherapy (NAC). Methods: A survival analysis was performed to detect the factors related to recurrence and [...] Read more.
Purpose: To evaluate the clinical characteristics, pathological response, and prognostic significance of hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer (BC) after neoadjuvant chemotherapy (NAC). Methods: A survival analysis was performed to detect the factors related to recurrence and death in 3070 consecutive patients with HR+/HER2− BC who received NAC from 2011 to 2022. All patients received current “standard of care” following neoadjuvant therapy based on guidelines, including surgery and adjuvant endocrine therapy. HER2-low was defined as immunohistochemistry (IHC) 1+ or IHC 2+ and fluorescence in-situ hybridization-negative. Results: The complete pathological response (pCR) (ypT0/is ypN0) rate was 14.5%. The clinical tumor size (cT), ER scores, PR status, and Ki67 levels were related to pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 82.6% and 90.4%, respectively. PR, Ki67 levels, and postmastectomy radiotherapy were independent factors for DFS and OS, and the extranodal extension (ENE) correlated with DFS. However, pCR and HER2 status were related to OS. The pCR rate in PR negativity BC was significantly higher than that in PR positivity BC (21.1% vs. 12.2%, p = 0.000), but PR negativity BC had a poorer prognosis than PR positivity BC. HER2-low BC showed high ER scores (over 50%), PR positivity, large ypT, ENE, and lymphovascular invasion but a lower pCR rate than HER2-zero BC. Patients with HER2-low BC had shorter OS than those with HER2-zero BC (p = 0.037). However, there was no difference in DFS. Conclusions: Depending on PR status and HER2 status, patients with ER positivity and HER2 negativity exhibit different pathologic complete response rates to neoadjuvant chemotherapy and long-term outcomes, especially patients with PR negativity or HER2-low status. Full article
(This article belongs to the Special Issue Post-neoadjuvant Strategies in Breast Cancer)
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11 pages, 1233 KiB  
Article
Surgery after Neoadjuvant Chemotherapy: A Clip-Based Technique to Improve Surgical Outcomes, a Single-Center Experience
by Carola Minella, Andrea Villasco, Marta D’Alonzo, Lisa Cellini, Francesca Accomasso, Silvia Actis and Nicoletta Biglia
Cancers 2022, 14(9), 2229; https://doi.org/10.3390/cancers14092229 - 29 Apr 2022
Cited by 5 | Viewed by 2330
Abstract
Background: This study aims to describe the surgical management of breast cancer patients after neoadjuvant chemotherapy, with attention to the impact on surgical outcomes of a clip-based marking technique. Methods: Patients who underwent NACT at the Breast Unit of the A. O Ordine [...] Read more.
Background: This study aims to describe the surgical management of breast cancer patients after neoadjuvant chemotherapy, with attention to the impact on surgical outcomes of a clip-based marking technique. Methods: Patients who underwent NACT at the Breast Unit of the A. O Ordine Mauriziano of Turin from January 2018 and had a surgical intervention by January 2022 were included. Data on the feasibility of clip insertion, after-treatment visibility, and successful removal during surgery were collected prospectively. Surgical outcomes in terms of breast-conserving surgery and axillary dissection reduction were described. Results: In 51 patients who had surgery after NACT, 55 clips were placed (34 breast and 21 axillary clips). Ultrasound visibility of the clips was optimal (91%) as well as preoperative localization and retrieval within the surgical specimen. Moreover, the use of the clip positively affected surgical outcomes. In our study, clip insertion allowed to avoid mastectomy and axillary dissection in patients with a complete radiological response. Conclusions: In our findings, the use of breast and/or lymph node clips has proved to be a simple and effective method to improve surgical conservative management of breast cancer patients after NACT. Full article
(This article belongs to the Special Issue Post-neoadjuvant Strategies in Breast Cancer)
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Review

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18 pages, 804 KiB  
Review
Post-Neoadjuvant Treatment Strategies for Patients with Early Breast Cancer
by Elisa Agostinetto, Flavia Jacobs, Véronique Debien, Alex De Caluwé, Catalin-Florin Pop, Xavier Catteau, Philippe Aftimos, Evandro de Azambuja and Laurence Buisseret
Cancers 2022, 14(21), 5467; https://doi.org/10.3390/cancers14215467 - 7 Nov 2022
Cited by 5 | Viewed by 4694
Abstract
Pre-surgical treatments in patients with early breast cancer allows a direct estimation of treatment efficacy, by comparing the tumor and the treatment. Patients who achieve a pathological complete response at surgery have a better prognosis, with lower risk of disease recurrence and death. [...] Read more.
Pre-surgical treatments in patients with early breast cancer allows a direct estimation of treatment efficacy, by comparing the tumor and the treatment. Patients who achieve a pathological complete response at surgery have a better prognosis, with lower risk of disease recurrence and death. Hence, clinical research efforts have been focusing on high-risk patients with residual disease at surgery, who may be “salvaged” through additional treatments administered in the post-neoadjuvant setting. In the present review, we aim to illustrate the development and advantages of the post-neoadjuvant setting, and to discuss the available strategies for patients with early breast cancer, either approved or under investigation. This review was written after literature search on main scientific databases (e.g., PubMed) and conference proceedings from major oncology conferences up to 1 August 2022. T-DM1 and capecitabine are currently approved as post-neoadjuvant treatments for patients with HER2-positive and triple-negative breast cancer, respectively, with residual disease at surgery. More recently, other treatment strategies have been approved for patients with high-risk early breast cancer, including the immune checkpoint inhibitor pembrolizumab, the PARP inhibitor olaparib and the CDK 4/6 inhibitor abemaciclib. Novel agents and treatment combinations are currently under investigation as promising post-neoadjuvant treatment strategies. Full article
(This article belongs to the Special Issue Post-neoadjuvant Strategies in Breast Cancer)
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10 pages, 422 KiB  
Review
Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies
by Natalia Krawczyk, Tanja Fehm, Eugen Ruckhaeberle, Laura Brus, Valeria Kopperschmidt, Achim Rody, Lars Hanker and Maggie Banys-Paluchowski
Cancers 2022, 14(12), 3002; https://doi.org/10.3390/cancers14123002 - 18 Jun 2022
Viewed by 2247
Abstract
Patients with high-risk non-metastatic breast cancer are recommended for chemotherapy, preferably in the neoadjuvant setting. Beyond advantages such as a better operability and an improved assessment of individual prognosis, the preoperative administration of systemic treatment offers the unique possibility of selecting postoperative therapies [...] Read more.
Patients with high-risk non-metastatic breast cancer are recommended for chemotherapy, preferably in the neoadjuvant setting. Beyond advantages such as a better operability and an improved assessment of individual prognosis, the preoperative administration of systemic treatment offers the unique possibility of selecting postoperative therapies according to tumor response. In patients with HER2-positive disease, both the escalation of therapy in the case of high-risk features and the de-escalation in patients with a low tumor load are currently discussed. Patients with small node-negative tumors receive primary surgery and, upon confirmation of pathological T1 N0 status, de-escalated adjuvant therapy with paclitaxel and trastuzumab. For those with a large tumor and/or nodal involvement, neoadjuvant polychemotherapy with a dual antibody blockade is recommended. Patients with invasive residual disease benefit from switching postoperative therapy to the antibody-drug-conjugate trastuzumab emtansine (T-DM1). In this review, we discuss current evidence and controversies regarding post-neoadjuvant treatment strategies in HER2-positive breast cancer. Full article
(This article belongs to the Special Issue Post-neoadjuvant Strategies in Breast Cancer)
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10 pages, 259 KiB  
Review
Post-Neoadjuvant Treatment Strategies in Breast Cancer
by Christiane Matuschek, Danny Jazmati, Edwin Bölke, Bálint Tamaskovics, Stefanie Corradini, Wilfried Budach, David Krug, Svjetlana Mohrmann, Eugen Ruckhäberle, Tanja Fehm, Carolin Nestle Krämling, Markus Dommach and Jan Haussmann
Cancers 2022, 14(5), 1246; https://doi.org/10.3390/cancers14051246 - 28 Feb 2022
Cited by 8 | Viewed by 3219
Abstract
Neoadjuvant chemotherapy enables close monitoring of tumor response in patients with breast cancer. Being able to assess tumor response during treatment provides an opportunity to evaluate new therapeutic strategies. Thus, for triple-negative breast tumors, it was demonstrated that additional immunotherapy could improve prognosis [...] Read more.
Neoadjuvant chemotherapy enables close monitoring of tumor response in patients with breast cancer. Being able to assess tumor response during treatment provides an opportunity to evaluate new therapeutic strategies. Thus, for triple-negative breast tumors, it was demonstrated that additional immunotherapy could improve prognosis compared with chemotherapy alone. Furthermore, adjuvant therapy can be escalated or de-escalated correspondingly. The CREATE-X trial randomly assigned HER2-negative patients with residual tumor after neoadjuvant therapy to either observation or capecitabine. In HER2-negative patients with positive BRCA testing, the OlympiA study randomly assigned patients to either observation or olaparib. HER2-positive patients without pathologic remission were randomly assigned to trastuzumab or trastuzumab–emtansine within the KATHERINE study. These studies were all able to show an improvement in oncologic outcome associated with the escalation of therapy in patients presenting with residual tumor after neoadjuvant treatment. On the other hand, this individualization of therapy may also offer the possibility to de-escalate treatment, and thereby reduce morbidity. Among WSG-ADAPT HER2+/HR-, HER2-positive patients achieved comparable results without chemotherapy after complete remission following neoadjuvant treatment. In summary, the concept of post-neoadjuvant therapy constitutes a great opportunity for individualized cancer treatment, potentially improving outcome. In this review, the most important trials of post-neoadjuvant therapy are compiled and discussed. Full article
(This article belongs to the Special Issue Post-neoadjuvant Strategies in Breast Cancer)
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