Preoperative neoadjuvant systemic therapy can be valuable for patients even if they do not achieve a pathologic complete response (pCR), according to Hyman B. Muss, MD, a professor of medicine and director of Geriatric Oncology at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.
In fact, Muss said, achieving pCR is a rarity in many settings and is not an optimal endpoint for preoperative therapy. He said these treatments have mostly involved chemotherapy but "evolving data suggest a major role for endocrine therapy in this setting."
Muss noted that the rationale for preoperative therapy is mainly to downstage the patient before surgery, thus increasing the chances of a more successful procedure.
"My view is you give your best therapy up front, depending on your style," he said.
Muss said clinical trials that investigate systemic therapy are "desperately needed for patients with all tumor categories who do not achieve a pCR."
Meanwhile, he suggested that clinicians would find 3 calculators developed by MD Anderson Cancer Center at the University of Texas helpful in making treatment decisions.
These clinical calculators can be used to make decisions about primary chemotherapy in breast cancer patients to predict: 1) response to neoadjuvant chemotherapy, 2) disease-free survival after surgery, and 3) residual cancer burden. You can access the calculators at http://tiny.cc/z6tyo