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December 12, 2007

Preoperative Chemotherapy for Breast Cancer: Miracle or Mirage?

Author Affiliations

Author Affiliations: Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, Weill College of Medicine, Cornell University, New York, New York.

JAMA. 2007;298(22):2665-2667. doi:10.1001/jama.298.22.2665

Conventional postoperative systemic treatment programs consisting of chemotherapy, hormonal interventions, and biologic agents have been shown to improve disease-free and overall survival in large cohorts of patients in randomized trials.1,2 These adjuvant regimens represent significant advances in oncology because they provide a public health benefit and represent the application of evidence-based medicine. When initially adopted, adjuvant therapy for breast cancer required a shift in thinking about systemic treatment for cancer, because it included the use of potentially toxic drugs in patients, some of whom were presumably already cured of malignancy.3 The inability to identify subsets of patients with viable micrometastatic disease led to the treatment of large, unselected patient populations in the adjuvant setting. The magnitude of this issue became potentially greater as thresholds for treatment were lowered and overall outcomes for all patients with early stage breast cancer improved. To address this challenge, newer tools (ie, genomic analysis) have been introduced in combination with conventional assessments (grade, receptor expression, tumor size, and nodal status) to stratify patients for specific systemic therapies.4,5