Treatment given to weaken and destroy breast cancer BEFORE surgery is called neoadjuvant treatment. Neoadjuvant treatment isn't routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive. Neoadjuvant treatment may be more commonly used before surgery for breast cancer that has spread outside the breast to other tissue in the breast area (locally advanced).
One or more chemotherapy medicines typically are used in a neoadjuvant regimen. The targeted therapies Herceptin (chemical name: trastuzumab) and Tykerb (chemical name: lapatinib) also may be used in a neoadjuvant regimen if the cancer is HER2-positive. HER2-positive breast cancers have too many copies of the HER2/neu gene, which make too much of the HER2 protein. HER2-positive breast cancers tend to be aggressive, so doctors may recommend neoadjuvant treatment for them.
One way doctors judge the effectiveness of neoadjuvant treatment is looking at the tissue removed during surgery to see if any active cancer cells are present. If no active cancer cells are present, doctors call it a "pathologic complete response." Still, researchers wonder if a pathologic complete response after neoadjuvant treatment is linked to a better prognosis after surgery.
A study found that women who got neoadjuvant treatment and had a complete pathologic response were less likely to have the cancer come back (recurrence) compared to women who didn't have a complete pathologic response. Three years after surgery, the women with a complete pathologic response were:
- more likely to be alive without the cancer coming back (disease-free survival)
- more likely to be alive whether or not the cancer had come back (overall survival)
These results were presented at the 2010 San Antonio Breast Cancer Symposium (SABCS).
In this study, called TECHNO, 217 women diagnosed with early-stage HER2-positive breast cancer or inflammatory breast cancer got a neoadjuvant regimen that included three chemotherapy medicines and Herceptin. After neoadjuvant treatment, 64% of the women had lumpectomy and the rest had mastectomy. One goal of this study was to better understand the link between response to neoadjuvant treatment and prognosis after surgery.
About 39% of the women had a pathologic complete response to neoadjuvant treatment. The researchers compared how these women did during the 3 years after surgery to how the women who didn't have a complete pathologic response did in the 3 years after surgery:
- 88% of the women who had a pathologic complete response were alive with no recurrence (disease-free survival) compared to 73% of women who didn't have pathologic complete response
- 96% of the women who had a pathologic complete response were alive compared to 86% of women who didn't have pathologic complete response
Because the women who didn't have a pathologic complete response to neoadjuvant treatment had a worse 3-year prognosis, the researchers believe that a more aggressive treatment plan after surgery should be considered for these women.
Much other research is studying the benefits and risks of various neoadjuvant regimens for some women diagnosed with early-stage or locally advanced breast cancer. Knowing that pathologic complete response is linked to a better prognosis will help doctors as they interpret the results of the research.
If you've recently been diagnosed with early-stage or locally advanced breast cancer and haven't had surgery yet, you might want to ask your doctor if neoadjuvant treatment makes sense for you (especially if the cancer is HER2-positive). Together, you and your doctor can decide on the best treatment plan for you and your unique situation.