Neoadjuvant chemotherapy: What you need to know
Neoadjuvant chemotherapy is a pre-surgical treatment for breast cancer that is administered before the main surgical procedure.
In this article, consultant clinical oncologist Dr Shiroma De Silva-Minor explains the applications and advantages of this approach.
Tumour shrinkage
Neoadjuvant chemotherapy is utilised to shrink the tumour. This makes the tumour easier to remove surgically, leading to less extensive procedures and improved cosmetic outcomes afterwards.
Treatment response
Oncologists monitor how the tumour responds to the chemotherapy, which can provide invaluable information for post-surgical treatment decisions.
The aim of the treatment is to achieve pathological complete response (pCR), where the tumour has completely ‘melted away’ by the time that the surgical specimen is looked at under a microscope. In this case, there is a much better chance that the cancer will never recur.
If there are still traces of cancerous tissues, this allows the opportunity to intensify the treatment after surgery with a different drug – a ‘second bite of the cherry’ so to speak – a technique which has demonstrated improved breast cancer outcomes.
Immediacy of systemic therapy
Using systemic therapies as the first treatment for breast cancer enables other treatments to target cancer cells throughout the body, addressing both the primary tumour and any potential microscopic metastases.
Neoadjuvant chemotherapy utilised for breast cancer patients can mean that the patient only has to undergo a lumpectomy to remove their tumour from their breast tissues, rather than a full mastectomy. It is particularly beneficial for certain subtypes of breast cancer, such as HER2-positive and triple-negative breast cancers. Some drugs used in the treatment of breast cancer are most beneficial when used in a neoadjuvant setting, rather than administered after surgery. There is emerging evidence from clinical trials that indicates that it may be possible to spare patients from additional radiotherapy in certain cases, if there has been a complete pathological response to neoadjuvant chemotherapy.
The treatment regimen for neoadjuvant chemotherapy typically involves several cycles of chemotherapy drugs, which are tailored to the cancer type, the patient's overall health, circumstances, and personal preferences. Regular monitoring through imaging and clinical examination is crucial to assess the pCR and make necessary adjustments in order to optimise the treatment for the patient.