Neoadjuvant therapy in operable breast cancer: Application to human epidermal growth factor receptor 2-overexpressing tumors

Neoadjuvant (NA) chemotherapy is the standard of care for patients with large, inoperable tumors or inflammatory breast cancer, but it is also considered for women with operable disease. Several trials have demonstrated equivalent survival benefits for the administration of chemotherapy before or after surgery. Moreover, preoperative treatment allows a higher rate of breast conserving surgery. NA treatment with a sequential anthracycline-taxane based chemotherapy in combination with targeted human epidermal growth factor receptor 2 (HER2) therapy is the gold standard treatment for patients with HER2-positive breast cancer. This approach is based on the higher pathologic complete response (pCR) seen with the addition of trastuzumab. The pCR can be increased with dual HER2-receptor blockade and chemotherapy. Patients with a pCR after chemotherapy and trastuzumab showed a significantly better outcome. This review, based on an exhaustive summary of current literature, highlights the benefits of NA systemic therapy in HER2 positive operable breast cancer.