Advances in Neoadjuvant and Adjuvant Therapy for Breast Cancer

Systemic therapy for breast cancer is evolving rapidly. The medical treatment of cancer includes chemotherapy, endocrine therapy, and therapy with targeted biologic agents. In the past, a patient’s stage, based on tumor size and nodal involvement, would determine the recommendations for medical therapy, whereas now the biologic features of the tumor direct the treatment plan. As a result of advances in the understanding of these biologic features, individualized systemic therapy is effective, less toxic, and directed at the tumor profile. Systemic treatment may influence the surgical and radiation options; thus surgeons should be involved with these medical decisions in both the neoadjuvant and adjuvant settings. In view of the many treatment options available, a multidisciplinary approach, starting at the time of diagnosis, can provide a tailored plan that results in the best outcome for patients. The adjuvant and neoadjuvant therapy for operable stages I, II, and III breast cancer are described in this chapter.