Post-neoadjuvant strategies in breast cancer: From risk assessment to treatment escalation. (January 2019)

• Record Type: Journal Article
• Authors: Pelizzari, Giacomo; Gerratana, Lorenzo; Basile, Debora; Fanotto, Valentina; Bartoletti, Michele; Liguori, Alessia; Fontanella, Caterina; Spazzapan, Simon; Puglisi, Fabio
• Is Part Of: Cancer treatment reviews. Volume 72(2019)
• Page Start: 7
• Page End: 14
• Publication Date: 2019-01
• Subjects: Breast cancer -- Post-neoadjuvant treatment -- pCR -- Residual disease; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2018.10.014
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: Achieving pCR after neoadjuvant treatment has a strong positive prognostic impact. Adjuvant therapies are not routinely recommended for patients without pCR after NAT. The post-neoadjuvant setting is an attractive scenery for adjuvant clinical trials. Adjuvant capecitabine showed a DFS and OS benefit in patients without pCR after NAT. TILs, CTC, ctDNA, RCB, and risk scores may be useful for risk-assessment after NAT. Abstract: The post-neoadjuvant setting in early breast cancer represents an attractive scenario for adjuvant clinical trials, offering the opportunity to test new drugs or combinations in high-risk patients who did not achieve pathologic complete response after primary treatment. No standard therapies are routinely proposed to patients with residual disease after neoadjuvant chemotherapy and few trials have explored this setting. To date, only one randomized phase III study showed the benefit of additional capecitabine after neoadjuvant chemotherapy, and international guidelines recommend at least to consider its use, particularly for triple negative breast cancer. Therefore, the management of these patients is still a clinical challenge, with limited data supporting the use of an additional adjuvant non-cross-resistant chemotherapy. Escalation strategies are currently under evaluation, with new agents proposed as supplementary post-neoadjuvant treatment (e.g. platinum salts, capecitabine, poly ADP-ribose polymerase inhibitors, immune checkpoint inhibitors, cyclin-dependent kinase 4/6 inhibitors). Based on these premises, selection criteria are critical to identify patients who may benefit from post-neoadjuvant therapies, through the validation of prognostic and predictive biomarkers for a reliable risk assessment and estimation of benefit. The present review summarizes the efforts in introducing new therapeutic options for patients with breast cancer and residual disease after neoadjuvant treatment, with a particular focus on the ongoing clinical trials and useful biomarkers for risk stratification.