Neoadjuvant chemotherapy
Neoadjuvant chemotherapy (NACT) is the term used to describe chemotherapy that is administered before surgery (“neo” = “new”, “adjuvant” = an addition to surgery). Chemotherapy given after surgery is referred to as adjuvant chemotherapy.
In some cases, the team may recommend neoadjuvant chemotherapy. This is an option offered for many reasons, but most often it is recommended with the intention to shrink the tumour so that breast surgery can be optimized. For example, it may mean that a tumour in a more difficult part of the breast for the surgeon can be more easily removed, retaining the best cosmetic outcome, and perhaps avoiding mastectomy (removal of the entire breast). Other reasons why patients may be advised to have chemotherapy before surgery include pregnancy, to delay surgery for other reasons, e.g. to allow the patient to quit smoking (smoking often impairs wound healing), or to participate in a clinical trial.
There has been a lot of research in recent times examining the success rates of NACT. This is measured by the amount of invasive cancer detected in the breast tissue following surgery. The best result we can hope to achieve is no invasive disease present when the surgical specimen is examined under a microscope. This is called pathological complete response (pCR) and means that the chemotherapy has killed all the active cancer cells in the breast. There is no cancer left.
Research has indicated that an increased rate of pCR occurs in patients with either HER2 positive or "triple negative" breast cancer. In these subtypes of breast cancer, the rate of complete response after chemotherapy are on average 40%. This does not mean that NACT does not work in hormone receptor positive breast cancers, it is simply a reflection of what we already know; oestrogen receptor positive breast cancers are often more responsive to endocrine therapies such as Tamoxifen, Femara or Arimidex. There are clinical trials currently examining this concept, such as the ELIMINATE study. The aim of this study is to determine if giving a combination of endocrine therapy and chemotherapy upfront results in higher rates of complete response in comparison to those patients who have neoadjuvant chemotherapy alone. Watch this space for the results.
For information regarding commonly used chemotherapy regimens in breast cancer, click here.
In some cases, the team may recommend neoadjuvant chemotherapy. This is an option offered for many reasons, but most often it is recommended with the intention to shrink the tumour so that breast surgery can be optimized. For example, it may mean that a tumour in a more difficult part of the breast for the surgeon can be more easily removed, retaining the best cosmetic outcome, and perhaps avoiding mastectomy (removal of the entire breast). Other reasons why patients may be advised to have chemotherapy before surgery include pregnancy, to delay surgery for other reasons, e.g. to allow the patient to quit smoking (smoking often impairs wound healing), or to participate in a clinical trial.
There has been a lot of research in recent times examining the success rates of NACT. This is measured by the amount of invasive cancer detected in the breast tissue following surgery. The best result we can hope to achieve is no invasive disease present when the surgical specimen is examined under a microscope. This is called pathological complete response (pCR) and means that the chemotherapy has killed all the active cancer cells in the breast. There is no cancer left.
Research has indicated that an increased rate of pCR occurs in patients with either HER2 positive or "triple negative" breast cancer. In these subtypes of breast cancer, the rate of complete response after chemotherapy are on average 40%. This does not mean that NACT does not work in hormone receptor positive breast cancers, it is simply a reflection of what we already know; oestrogen receptor positive breast cancers are often more responsive to endocrine therapies such as Tamoxifen, Femara or Arimidex. There are clinical trials currently examining this concept, such as the ELIMINATE study. The aim of this study is to determine if giving a combination of endocrine therapy and chemotherapy upfront results in higher rates of complete response in comparison to those patients who have neoadjuvant chemotherapy alone. Watch this space for the results.
For information regarding commonly used chemotherapy regimens in breast cancer, click here.