ASCO Guideline: Focus on Optimal Neoadjuvant Therapy for Breast Cancer
Posted: Monday, March 1, 2021
An expert panel convened by the American Society of Clinical Oncology (ASCO) developed recommendations for optimal neoadjuvant therapy for breast cancer, published in the Journal of Clinical Oncology. Dawn L. Hershman, MD, of the Herbert Irving Comprehensive Cancer Center at Columbia University, New York, and colleagues conducted a systematic review of the literature on neoadjuvant therapy, focusing on more than 40 eligible articles, to provide care options for patients with invasive disease.
The panel’s main findings outlined recommendations based on patient characteristics, cancer subtype, and clinical presentation. The guideline suggested that a multidisciplinary care team should manage patients undergoing neoadjuvant therapy, and neoadjuvant therapy could be used to reduce the extent of local therapy. They also found that patients with specific subtypes of the disease should not be routinely offered neoadjuvant therapy.
"As our understanding of the biology of breast cancer has evolved in recent decades, it has become clear that optimal therapy for breast cancer is driven by subtype. Thus, older neoadjuvant trials that used a one-size-fits-all approach to therapy selection are less relevant in the current era of biologically driven treatment selection," stated Dr. Hershman and colleagues.
More than 40 articles met eligibility criteria for review and formed the evidentiary basis for the published guidelines. Findings revealed that appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those for whom the residual disease may prompt a change in therapy. Additionally, patients with triple-negative breast cancer who have clinically node-positive and/or at least T1c disease should be offered anthracycline- and taxane-containing regimens. In contrast, those with cT1a or cT1bN0 subtypes should not be offered neoadjuvant therapy. Findings also revealed that neoadjuvant therapy might be used in patients with hormone receptor–positive and HER2-negative tumors when a treatment decision can be made without surgical information and among postmenopausal patients to downstage the disease.
Disclosure: For full disclosure of the study panel members, visit ascopubs.org.