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Induction Chemotherapy for Breast Cancer

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Induction Chemotherapy

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Abstract

Induction chemotherapy, also known as primary, preoperative or neoadjuvant chemotherapy, for breast cancer is indicated in locally advanced breast cancer (LABC) and patients with stage II–III disease in order to downstage the tumour burden and ensure appropriate breast conservation. Induction therapy treatment also makes it possible to evaluate drug sensitivity. The achievement of tumour and nodal pathological complete remission (pCR) or minimal residual disease (MDR: <1 cm) favourably affects disease-free survival (DFS) and overall survival (OS).

Induction chemotherapy is suitable for patients with HER2-positive or triple-negative breast cancer (TNBC) and HR-negative, PR-negative and HER2-negative breast cancer who are most likely to have a good locoregional response to treatment, irrespective of the size of their breast cancer at presentation.

The most frequently recommended regimen for patients undergoing induction chemotherapy is the combination of an anthracycline (doxorubicin or epirubicin) + cyclophosphamide ± 5-FU followed by taxanes (weekly paclitaxel or docetaxel). For patients who cannot receive anthracycline therapy, docetaxel in combination with cyclophosphamide is a good compromise.

The addition of carboplatin to standard induction therapy for patients suffering from a TNBC, particularly with the BRCA 1/2 mutation, is judicious. The addition to induction treatment of a HER2-directed therapy for patients who are HER2-positive is advised. Trastuzumab is largely used in this category of patients; recent data are available to indicate that pertuzumab in this setting improves overall survival. The administration of both trastuzumab and pertuzumab increases the pCR rate compared to trastuzumab alone.

Chemotherapy rather than endocrine therapy for induction therapy is usually suggested for patients with hormone receptor-positive, HER2-negative breast cancers. For premenopausal patients with hormone receptor-positive, HER2-negative breast cancers who are not candidates for chemotherapy, endocrine therapy is reasonable using an aromatase inhibitor. There is not enough data available to assess the role of endocrine therapy in premenopausal patients.

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Acknowledgment

We recognise Dr Steve Johnson MD, PhD, and Madame Jennifer Tavassoli for their useful expertise and advice.

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Authors and Affiliations

  1. Service d’Oncologie Médicale, Groupe Hospitalier Pitié Salpêtrière, 47 Boulevard de l’Hôpital, Paris, 75013, France

    François-Michel Delgado, Maria Angeles Gil-Delgado & David Khayat

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  1. François-Michel Delgado
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  2. Maria Angeles Gil-Delgado
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Correspondence to François-Michel Delgado .

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  1. Department of Surgical Oncology, Medias Klinikum GmbH & Co KG, Burghausen, Germany

    Karl Reinhard Aigner

  2. Royal Prince Alfred, Sydney Hospitals, Mosman, New South Wales, Australia

    Frederick O. Stephens

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Delgado, FM., Gil-Delgado, M.A., Khayat, D. (2016). Induction Chemotherapy for Breast Cancer. In: Aigner, K., Stephens, F. (eds) Induction Chemotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-28773-7_9

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  • DOI: https://doi.org/10.1007/978-3-319-28773-7_9

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