Neoadjuvant therapy

Authors: Sarah Gierahn Nielsen, med. student & Hanne Melgaard Nielsen, MD

Types of neoadjuvant treatment

• Chemotherapy
• HER2 targeted therapy (only HER2+ positive breast cancer)
• Hormone therapy (only ER+ or PR+ positive breast cancer)

Neo-adjuvant therapy, including neo-adjuvant chemotherapy (NACT), is given before intended curative surgery. It is either given to down-size the tumor (to be able to perform breast conservative surgery instead of mastectomy), to downstage the axillary lymph node metastasis in order to reduce axillary dissection, and in case of locally advanced breast cancer (LABC) to downstage tumor and/or lymph nodes in order to make the patient operable.

Neoadjuvant chemotherapy should be considered to downstage tumor and/or axilla when:

• Patients are candidates for adjuvant chemotherapy
• Tumor size is >2 cm, but <= 5 cm
• Lymph node involvement is not more than clinical stage N1
• Histological verified as Non-lobular invasive mammary carcinoma

Examinations and procedures before neoadjuvant therapy

• MR Mammography
• Normal blood samples
• Chest X Ray
• A description of the following
  • Histological subtype of breast cancer
  • Hormone receptor status ( ER+ or PR+ status)
  • Human epidermal growth factor receptor 2 status (i.e. HER2+)
  • Histological grading if possible