%0 Journal Article
%T Neoadjuvant treatment: the MD Anderson experience
%A GN Hortobagyi
%J Breast Cancer Research
%D 2005
%I BioMed Central
%R 10.1186/bcr1222
%X Published studies of anthracycline-based preoperative chemotherapy demonstrate pCR rates of up to 17%. Several recently reported studies including the sequential use of anthracycline-based regimens and taxanes have achieved significantly higher pathologic responses, ranging from 25% to 34%. Our studies focused on the sequential use of anthracyclines and taxanes, showing excellent tolerance and efficacy of this strategy. In addition, we demonstrated the therapeutic superiority of weekly paclitaxel in this setting. These findings were subsequently confirmed by much larger, randomized trials conducted by another cooperative group. We used the neoadjuvant strategy for the initial evaluation of trastuzumab in patients with primary breast cancer. That small randomized trial indicated an almost threefold increase in pCR with the addition of trastuzumab to chemotherapy.Currently, we conduct studies with gene profiling in the neoadjuvant setting to determine predictors of pCR, and therefore long-term prognosis, and to develop individualized medicine for patients with primary breast cancer.There are multiple remaining questions related to the use of this strategy, however. Some pertain to optimal local-regional therapies: when should axillary assessment be performed in relation to NACT, what should be the criteria for administration of postmastectomy radiation therapy following NACT, and how to optimally perform breast-conserving surgery following NACT. The role and relative timing of neoadjuvant hormone therapy (NAHT) is also under intensive evaluation at this time. This is solely relevant to the group of patients with hormone receptor-positive tumors, but has potential impact on the type and sequence of local, regional and systemic therapies.
%U http://breast-cancer-research.com/content/7/S1/S18