State of the art in neoadjuvant therapy of breast cancer

Neoadjuvant therapy is no longer an option just for locally advanced operable cancers in order to facilitate breast-conserving surgery, but also for all early breast cancers when an indication for chemotherapy is given [1]. Pathological complete response (pCR) – defined as the absence of residual invasive or sometimes even in-situ cancer on breast and lymph nodes after preoperative therapy – has been shown to predict long-term outcome in patient-based analyses of several randomised clinical trials [2–4]. Achieving pCR is important mainly for those patients with an unfavourable initial prognosis, such as HER2-positive/hormone-receptor(HR-)negative, triple-negative breast cancer (TNBC) and some luminal-B-like tumours. In contrast, the survival benefit of patients with pCR was less pronounced in luminal-A-like tumours (HR-positive, HER2-negative, grade 1–2) [2,4]. Because of the different behaviours of breast cancer subtypes, a neoadjuvant strategy tailored on clinicopathological criteria should be considered the optimal option (Table 1).