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Primary or neoadjuvant systemic chemotherapy, initially described for patients with locally advanced or borderline inoperable breast cancer, has been increasingly utilized for patients with less advanced or operable breast cancer. Theoretically, primary systemic therapy could inhibit the rapid growth of metastases after surgery and may decrease the emergence of chemoresistant clones of cells. On a practical level, primary systemic therapy has the potential to increase the use of breast conservation by decreasing tumor size. Beginning in 1988, the National Surgical Adjuvant Breast and Bowel Project (NSABP) cooperative group conducted two sequential trials to test the value of neoadjuvant chemotherapy and to optimize the treatment regimen for operable breast cancers.

Primary chemotherapy for operable breast cancer: the NSABP experience