Neoadjuvant treatment: the future of patients with breast cancer

In a recent paper published in the British Medical Journal by Vaidya and colleagues,1 the authors call for reconsidering the routine use of neoadjuvant chemotherapy in patients with breast cancer. Their main arguments are (1) the increased risk of locoregional recurrence, (2) the imperfect correlation between the response to primary chemotherapy and overall survival, and (3) the complexity of surgery after neoadjuvant chemotherapy. We strongly disagree with this opinion paper.First, great care should be applied in interpreting 15-year locoregional recurrence rates published in the recent Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analysis,2 as considerable changes have occurred in the past 15 years in terms of diagnosis and staging (MRI, ultrasound, PET/CT), medical treatments (chemotherapy/targeted therapy/endocrine therapy), surgical techniques and radiation protocols. Similar hot debates on the increased risk of local relapse emerged in the transition period from radical Halstedt mastectomy to breast conservating surgery plus radiation therapy, with the latter no longer being controversial as a standard of care.Second, in response to the inconsistent relationship between treatment response and survival, the authors advocate to limit the use of neoadjuvant chemotherapy (NAC). Contrarily, we see this theme as a great opportunity to better understand …