Post-neoadjuvant treatment and the management of residual disease in breast cancer: state of the art and perspectives

Achieving a pathologic complete response after neoadjuvant treatment is associated with improved prognosis in breast cancer. The CREATE-X trial demonstrated a significant survival improvement with capecitabine in patients with residual invasive disease after neoadjuvant chemotherapy, and the KATHERI...

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Bibliographic Details
Published in:Therapeutic Advances in Medical Oncology 2019-02, Vol.11, p.1758835919827714-1758835919827714
Main Authors: Caparica, Rafael, Lambertini, Matteo, Pondé, Noam, Fumagalli, Debora, de Azambuja, Evandro, Piccart, Martine
Format: Article
Language:English
Subjects:
Breast cancer
Cancer therapies
Chemotherapy
Clinical trials
Cyclin-dependent kinase
Cyclin-dependent kinase inhibitors
Cyclin-dependent kinases
Epidermal growth factor
ErbB-2 protein
Gene expression
Immune checkpoint inhibitors
Invasiveness
Medical prognosis
Metastases
Monoclonal antibodies
Next-generation sequencing
Review
Risk groups
Targeted cancer therapy
Trastuzumab
Treatment resistance
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Summary:Achieving a pathologic complete response after neoadjuvant treatment is associated with improved prognosis in breast cancer. The CREATE-X trial demonstrated a significant survival improvement with capecitabine in patients with residual invasive disease after neoadjuvant chemotherapy, and the KATHERINE trial showed a significant benefit of trastuzumab-emtansine (TDM1) in human epidermal growth factor receptor 2 (HER2)-positive patients who did not achieve a pathologic complete response after neoadjuvant treatment, creating interesting alternatives of post-neoadjuvant treatments for high-risk patients. New agents are arising as therapeutic options for metastatic breast cancer such as the cyclin-dependent kinase inhibitors and the immune-checkpoint inhibitors, but none has been incorporated into the post-neoadjuvant setting so far. Evolving techniques such as next-generation sequencing and gene expression profiles have improved our knowledge regarding the biology of residual disease, and also on the mechanisms involved in treatment resistance. The present manuscript reviews the current available strategies, the ongoing trials, the potential biomarker-guided approaches and the perspectives for the post-neoadjuvant treatment and the management of residual disease after neoadjuvant treatment in breast cancer.
ISSN:1758-8359
1758-8340
1758-8359
DOI:10.1177/1758835919827714