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<p>Neoadjuvant systemic therapy in early breast cancer has evolved from a&#xa0;primarily surgery-driven approach into a&#xa0;treatment concept based on tumor biology. It allows early treatment, direct in vivo assessment of tumor sensitivity to treatment, and evidence-based adjustment of postneoadjuvant therapy depending on the extent of residual disease. The prognostic value of a&#xa0;pathological complete response (pCR) is particularly pronounced in biologically aggressive subtypes (triple-negative, HER2-positive). In triple-negative breast cancer, platinum-based regimens and the integration of immune checkpoint inhibitors increase pCR rates and improve survival outcomes. Furthermore, there is an option of post-neoadjuvant escalation in the presence of invasive residual disease, for example, with capecitabine and, if a&#xa0;germline <i>BRCA1/2</i> mutation is present, with PARP inhibition. Antibody–drug conjugates (ADC) are currently being evaluated as additional options. In HER2-positive early breast cancer, chemotherapy plus (dual) HER2 blockade achieves high response rates. In cases without pCR, ADC escalation is indicated. By contrast, HR-positive/HER2-negative early breast cancer is more heterogeneous, and pCR occurs infrequently. Neoadjuvant chemotherapy is used selectively in high-risk settings, while neoadjuvant endocrine therapy in endocrine-sensitive tumors (e.g., with Ki-67 reduction) is employed to learn about the benefit from endocrine therapy. Overall, the neoadjuvant approach enables treatment optimization through strategies of escalation and de-escalation, with careful patient selection.</p>

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Neoadjuvante Therapie – Chancen der Therapieoptimierung

  • 期刊论文

  • 发表日期：

    2026年3月31日

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  • Oleg Gluz,
  • Lotta Ada Fischer,
  • Vesna Bjelic-Radisic,
  • Monika Graeser

摘要

Neoadjuvant systemic therapy in early breast cancer has evolved from a primarily surgery-driven approach into a treatment concept based on tumor biology. It allows early treatment, direct in vivo assessment of tumor sensitivity to treatment, and evidence-based adjustment of postneoadjuvant therapy depending on the extent of residual disease. The prognostic value of a pathological complete response (pCR) is particularly pronounced in biologically aggressive subtypes (triple-negative, HER2-positive). In triple-negative breast cancer, platinum-based regimens and the integration of immune checkpoint inhibitors increase pCR rates and improve survival outcomes. Furthermore, there is an option of post-neoadjuvant escalation in the presence of invasive residual disease, for example, with capecitabine and, if a germline BRCA1/2 mutation is present, with PARP inhibition. Antibody–drug conjugates (ADC) are currently being evaluated as additional options. In HER2-positive early breast cancer, chemotherapy plus (dual) HER2 blockade achieves high response rates. In cases without pCR, ADC escalation is indicated. By contrast, HR-positive/HER2-negative early breast cancer is more heterogeneous, and pCR occurs infrequently. Neoadjuvant chemotherapy is used selectively in high-risk settings, while neoadjuvant endocrine therapy in endocrine-sensitive tumors (e.g., with Ki-67 reduction) is employed to learn about the benefit from endocrine therapy. Overall, the neoadjuvant approach enables treatment optimization through strategies of escalation and de-escalation, with careful patient selection.