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International Expert Consensus on Primary Systemic Therapy in the Management of Early Breast Cancer: Highlights of the Fifth Symposium on Primary Systemic Therapy in the Management of Operable Breast Cancer, Cremona, Italy (2013). | LitMetric

International Expert Consensus on Primary Systemic Therapy in the Management of Early Breast Cancer: Highlights of the Fifth Symposium on Primary Systemic Therapy in the Management of Operable Breast Cancer, Cremona, Italy (2013).

J Natl Cancer Inst Monogr

Medical Oncology Unit (VA, ABe), University of Brescia, and Breast Unit (RP, LV, ELS) Spedali Civili Hospital, Brescia, Italy; U.O. Multidisciplinare di Patologia Mammaria, S.S. Terapia Molecolare e Farmacogenomica, AZ. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AR, MRC, LD, ABo); Departments of Radiation Oncology (TB) and Pathology (FS), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medical Oncology and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (MC); Division of Experimental Therapeutics, Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy (GC); Biomarkers Unit, Department of Experimental Oncology and Molecular Medicine (MGD), and Medical Oncology Unit (SDC), Fondazione IRCCS - Istituto Nazionale Tumori, Milan, Italy (MGD); Academic Department of Biochemistry, Biochemical Endocrinology (MD), Department of Surgery, Breast Unit (PB), and The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research and Breast Unit (MD, GS), Royal Marsden Hospital, London, UK; Department of Pathology, Melbourne University, Parkville, Australia (SF); Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK (ALH); Mount Vernon Cancer Centre, London, UK (AM); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Memorial Sloan Kettering Cancer Center, New York, NY (CAH); Division of Medical Oncology, Department of Hemato-oncology, IRCCS Policlinico 'San Matteo' Foundation, Pavia, Italy (PP); Dipartimento Medicina di Laboratorio, SC Anatomia ed Istocitopatologia Diagnostica e di Screening, A.O.U. Città della Salute e della Scienza di Torino, Università di Torino, Turin, Italy (AS); N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia (VS); German Breast Group & University of Frankfurt, Neu-Isenburg, Germany (GvM); The Russell H. Morgan Department of Radiology

Published: May 2015

AI Article Synopsis

  • Expert consensus recommendations highlight the importance of primary systemic treatment (PST) in early breast cancer, focusing on its role in evaluating new therapies and improving patient outcomes.
  • Neoadjuvant trials are advantageous due to their lower patient requirements, cost-effectiveness, and quicker achievement of endpoints like pathological complete response (pCR), which may correlate with better survival rates.
  • Accurately managing post-treatment residual disease is crucial, and while sentinel lymph-node surgery could reduce unnecessary axillary dissection in certain cases, more research is needed regarding radiation therapy adjustments after PST based on patient response.

Article Abstract

Expert consensus-based recommendations regarding key issues in the use of primary (or neoadjuvant) systemic treatment (PST) in patients with early breast cancer are a valuable resource for practising oncologists. PST remains a valuable therapeutic approach for the assessment of biological antitumor activity and clinical efficacy of new treatments in clinical trials. Neoadjuvant trials provide endpoints, such as pathological complete response (pCR) to treatment, that potentially translate into meaningful improvements in overall survival and disease-free survival. Neoadjuvant trials need fewer patients and are less expensive than adjuvant trial, and the endpoint of pCR is achieved in months, rather than years. For these reasons, the neoadjuvant setting is ideal for testing emerging targeted therapies in early breast cancer. Although pCR is an early clinical endpoint, its role as a surrogate for long-term outcomes is the key issue. New and better predictors of treatment efficacy are needed to improve treatment and outcomes. After PST, accurate management of post-treatment residual disease is mandatory. The surgery of the sentinel lymph-node could be an acceptable option to spare the axillary dissection in case of clinical negativity (N0) of the axilla at the diagnosis and/or after PST. No data exists yet to support the modulation of the extent of locoregional radiation therapy on the basis of the response attained after PST although trials are underway.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009414PMC
http://dx.doi.org/10.1093/jncimonographs/lgv023DOI Listing

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