Neoadjuvant Chemotherapy for Breast Cancer

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

Deadline for manuscript submissions: 30 April 2025 | Viewed by 2143

Special Issue Editor


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Guest Editor
Breast Surgery Division, Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
Interests: breast cancer treatment; biomarker development; surgical oncology
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Dear Colleagues,

One of the scientific backgrounds of neoadjuvant chemotherapy is the hypothesis that earlier treatment with the eradication of subclinical micrometastasis will improve survival. The pioneering clinical trials by the I-SPY2 working group have successfully identified the therapeutic agents through pCR improvement and established the "response predictor subtype".

Still, there are a lot of unresolved issues regarding the neoadjuvant chemotherapy of breast cancer, such as the predictor of pCR, the best sequence of the therapeutic regimen, the effective treatment of non-pCR patients, the role of conventional chemotherapy in terms of immunological effect, de-escalation after pCR, and escalation therapy for non-pCR. To breast surgeons, the extent of breast surgery and the efficacy of sentinel node biopsy after NAC and the best strategy for axillary management after nodal pCR are still controversial.

Through the Special Issue titled "Neoadjuvant Chemotherapy for Breast Cancer" of Cancers, all experts in this field are invited to contribute and submit their papers in an attempt to resolve the above issues.

Dr. Shin-Cheh Chen
Guest Editor

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Keywords

  • breast cancer
  • neoadjuvant chemotherapy
  • molecular subtype
  • response predictor
  • survival surrogate
  • immune checkpoint inhibitor
  • pathological complete response

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Published Papers (1 paper)

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Research

22 pages, 4617 KiB  
Article
Breast Cancer Patient’s Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II–III Disease
by Catalina Falo, Juan Azcarate, Sergi Fernandez-Gonzalez, Xavier Perez, Ana Petit, Héctor Perez, Andrea Vethencourt, Silvia Vazquez, Maria Laplana, Miriam Ales, Agostina Stradella, Bartomeu Fullana, Maria J. Pla, Anna Gumà, Raul Ortega, Mar Varela, Diana Pérez, Jose Luis Ponton, Sara Cobo, Ana Benitez, Miriam Campos, Adela Fernández, Rafael Villanueva, Veronica Obadia, Sabela Recalde, Teresa Soler-Monsó, Ana Lopez-Ojeda, Evelyn Martinez, Jordi Ponce, Sonia Pernas, Miguel Gil-Gil and Amparo Garcia-Tejedoradd Show full author list remove Hide full author list
Cancers 2024, 16(13), 2421; https://doi.org/10.3390/cancers16132421 - 30 Jun 2024
Cited by 1 | Viewed by 1772
Abstract
Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods [...] Read more.
Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan–Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1–1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions. Full article
(This article belongs to the Special Issue Neoadjuvant Chemotherapy for Breast Cancer)
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