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Gian Paolo Andreoletti, MD, Editor-in-Chief  -  paolo.andreoletti@senology.it

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Literature Selection

Editorial

  • "Preoperative chemotherapy is a safe procedure for patients with early breast cancer" - Janine van Nes,  Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
     
    "Patients with early breast cancer are treated with local therapy with or without systemic therapy. Systemic treatment improves disease free and overall survival and can be administrated before (neoadjuvant, preoperative, primary) or after (adjuvant, postoperative) local therapy. In the last century, several trials were initiated to compare preoperative chemotherapy to postoperative chemotherapy. None of these trials found a survival advantage for preoperative chemotherapy. One of these trials was the European Organization for Research and Treatment of Cancer (EORTC) 10902, or the Preoperative Chemotherapy in Operable Breast Cancer (POCOB) trial. The 10 years follow-up data were recently published in the Breast Cancer Research and Treatment. Although preoperative chemotherapy does not improve survival compared to postoperative chemotherapy, it is correlated with several potential advantages. First the ability to monitor treatment efficacy in vivo with the possibility to make appropriate changes in case of drug resistance. Second, it allows downsizing of tumours, making ineligible patients eligible for breast conserving therapy which results in a increased rate of breast conserving therapy. Moreover, there is no significant increase of locoregional recurrence rate if surgery is not omitted (surgery should always be part of local treatment, also in case of a complete response). This implies that tumour downsizing followed by breast conserving therapy is permitted and a safe procedure. Third it allows downstaging, preventing unnecessary axillary lymph node dissection procedures. Fourth, preoperative treatment is the keystone for translational research"
    (Comment on paper: 
    Van Nes JG et al.: "Preoperative chemotherapy is safe in early breast cancer, even after 10 years of follow-up; clinical and translational results from the EORTC trial 10902", Breast Cancer Res Treat. 2008. [Epub ahead of print])

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