Neoadjuvant treatment in breast cancer is that which is performed before breast surgery. It can be performed with chemotherapy or by hormone therapy. It is a treatment that has been used by specialists in Gynecology and Obstetrics in advanced breast cancer and in initially inoperable cases. More recently, this strategy has been extended to cases of operable breast cancer, especially to increase the chances of breast-conserving surgical treatment by reducing the size of the tumor.
Who can undergo neoadjuvant treatment?
The treatment is not necessary for all patients. In certain cases, depending on the aggressiveness of the tumor, the administration of chemotherapy improves the prognosis of patients. Therefore, its administration prior to surgery allows us to confirm the tumor’s chemosensitivity to the treatment that the patient needs, as well as providing the opportunity to change the treatment in the event of a lack of response to it, a situation that occurs infrequently. On the other hand, it is also indicated in situations in which the size of the tumor in relation to the mammary volume does not allow conservative treatment at the outset (i.e. resection of the tumor alone). In these situations neoadjuvant treatment makes it possible to reduce the size of the tumor in order to conserve the breast with oncological safety.
What does neoadjuvant treatment consist of?
Neoadjuvant chemotherapy is performed by infusion of drugs intravenously. The duration of treatment will depend on the type of drugs used, which are administered in weekly or three-weekly cycles, for a period of about 6 months.
Neoadjuvant hormone therapy, on the other hand, is a treatment administered by oral tablets once a day. It is indicated in postmenopausal patients in whom the tumor expresses estrogen and/or progesterone hormone receptors, and whose size does not permit conservative treatment. The duration of treatment can vary between 6 and 8 months.
Neoadjuvant chemotherapy is contraindicated in those patients who present any other pathology that contraindicates the use of a particular drug. For example, in patients with heart failure, drugs that increase cardiac toxicity cannot be used.
Results of neoadjuvant treatment
Long-term results have shown that standard chemotherapy and neoadjuvant chemotherapy have similar benefits with respect to survival and relapse rates. The advantages justifying their use are given to obtain a superior rate in terms of breast conservation. Statistics show that 23% of patients requiring mastectomy who underwent neoadjuvant therapy were able to benefit from more conservative surgery.
On the other hand, it has been demonstrated that, in tumors that can be treated conservatively and require chemotherapy, the reduction of the size of the tumor by neoadjuvant treatment allows less breast volume to be resected. This improves the aesthetic outcome of the breast and, therefore, the quality of life of patients.