Neoadjuvant chemotherapy

Fighting cancer typically involves more than one treatment. Most of the time, the disease requires a multidisciplinary approach, or a combination of therapies. Treatment plans often involve a primary therapy—generally “The word 'adjuvant' literally means helper or helping. It's essentially adding icing to the cake of the primary treatment.” - Issam Alawin, MD - Medical Oncologist at our hospital in Tulsa Neoadjuvant and adjuvant therapies are Most often, neoadjuvant and adjuvant therapies are recommended when a patient with early-stage cancer undergoes surgery or radiation therapy and the oncologist believes he or she may benefit from additional systemic treatments—or treatments that affect the entire body, Dr. Alawin says. “Let’s say a woman comes in with localized breast cancer, and the first-line treatment in this case is surgery, but to improve the chances that the surgery works as well as it can, we give chemotherapy three or four months before surgery, or three to four months after surgery,” he says. “Many times, there is a significant improvement in prognosis and a decreased risk of recurrence with doing either an adjuvant or neoadjuvant approach.” Neoadjuvant and adjuvant therapies benefit many, but not all, cancer patients. The type and stage of a patient’s cancer often dictate whether he or she is a candidate for additional treatment. For example, if surgery determines that cancer is found in a large number of lymph nodes, the risk rises that cancer cells may be ...

• The treatment effects associated with neoadjuvant chemotherapy can be seen in the primary tumor (tumor bed), axillary nodal metastases and normal breast tissue • Neoadjuvant chemotherapy improves survival and functional outcome by allowing resection in initially nonresectable disease or by reducing the extent of surgical resection • Degree of response (extent of residual disease) is predictive of outcome, in particular, a complete pathologic response without residual tumor detected is indicative of good prognosis ( • Indications for neoadjuvant chemotherapy include • Locally advanced disease, to allow resection of unresectable disease • Disease where breast conservation is not possible but potentially feasible if downstaging is achieved • Temporary / treatable conditions that contraindicate surgery and thus require bridging therapy ( • Clinically, node positive disease with response to neoadjuvant chemotherapy and negative sentinel lymph nodes may be spared from axillary dissection ( • Grade, stage and biomarker status are additional considerations for neoadjuvant chemotherapy ( • Clinical response to neoadjuvant chemotherapy is classified as • Clinical complete response: complete disappearance of tumor • Clinical partial response: ≥ 50% reduction greatest dimension of tumor • Clinically positive nodes may also respond (reduce in size) after neoadjuvant chemotherapy • Clinical assessment may overestimate tumor size due to posttreatment fibrosis ( • Clinical response is p...