[Primary systemic therapy of carcinoma of the breast - update of the geparduo studies].

Primary systemic therapy represents today the standard of care in patients with locally advanced breast cancer and becomes more and more an alternative to adjuvant postoperative chemotherapy in patients with operable breast cancer. In a subset of large randomized trials it could be shown that sequential schedules with more than 4 cycles can reach the highest rates of clinical and histopathological complete remissions. In two randomized trials (NSABP B-27, Geparduo) using 4 cycles of Adriamycin/Cyclophosphamide followed by 4 cycles of Docetaxel significant better results could be obtained in comparison with the referring control arm. New approaches try to further individualize chemotherapy, either using molecular biological tumor factors or the early effect of some chemotherapy cycles. In the Gepartrio study clinical response evaluation after 2 cycles can identify patients with a high or low chance for a histopathological complete remission and further treatment strategies can be developed for these different subgroups.