Ninewells Hospital and Medical School, Dundee Cancer Centre, Clinical Research Centre, University of Dundee, Dundee, UK.
Ann Oncol. 2012 Sep;23 Suppl 10(Suppl 10):x231-6. doi: 10.1093/annonc/mds324.
Neoadjuvant treatment of breast cancer has become established as the safe and often effective therapeutic approach of choice for larger primary and for locally advanced breast cancer. The neoadjuvant approach offers the advantages of downstaging the disease, potentially reducing the extent of surgery and in an era of individualization of therapy, testing the efficacy of therapy administered to patients. The preoperative setting is also an effective way to study the activity of novel agents or therapeutic combinations in vivo against human breast cancer. For new therapies, preoperative trials avoid the issue of adaptive resistance and pretreatments that can be problematic in the advanced disease setting. For evidence of a drug targeting the cancer in vivo, comparisons of endocrine therapy, chemotherapy agents and/or targeted agents can provide data on activity and efficacy with a much shorter time frame and many fewer patients than for adjuvant trials; effects seen in neoadjuvant trials may even reflect what is found in the adjuvant setting. Patient benefits from the neoadjuvant approach may be greatest for those who experience complete pathologically documented response (and the consequent survival benefits) and women for whom breast conservation, rather than mastectomy, becomes possible.
新辅助治疗乳腺癌已被确立为安全且通常有效的治疗选择，适用于较大的原发性和局部晚期乳腺癌。新辅助治疗具有使疾病降级的优势，可能减少手术的范围，并且在治疗个体化的时代，可以测试给予患者的治疗的疗效。术前环境也是在体内研究新型药物或治疗组合对人乳腺癌活性的有效方法。对于新的治疗方法，术前试验避免了适应性耐药的问题，而在晚期疾病环境中，预处理可能会出现问题。对于针对体内癌症的靶向药物的证据，内分泌治疗、化疗药物和/或靶向药物的比较可以提供在更短的时间框架内和更少的患者中具有活性和疗效的数据，比辅助试验多；在新辅助试验中观察到的效果甚至可能反映在辅助环境中发现的效果。新辅助治疗方法对那些经历完全病理记录的反应（并因此带来生存益处）的患者和那些可能进行保乳而不是乳房切除术的女性的益处最大。
