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Neoadjuvant Therapy of Breast Cancer: 2nd Edition

A Special Issue of Cancers (ISSN 2072-6694) belonging to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (25 August 2026) | Viewed by 353

Editors


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Guest Editor
Department of Breast Surgery, Sanno Hospital, 8-10-16 Akasaka, Minato-ku, Tokyo 107-0052, Japan
Interests: breast cancer; endocrine therapy; chemotherapy; surgical therapy; tumor angiogenesis
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Guest Editor
Division of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
Interests: tumor-infiltrating lymphocytes; FDG-PETCT; immune checkpoint inhibitors; angiogenesis; predictive markers for response
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue represents the second edition of “Neoadjuvant Therapy of Breast Cancer”; the first is available at https://www.mdpi.com/journal/cancers/special_issues/8LI3I016BD.

Perioperative systemic therapy for operable breast cancer is subdivided according to molecular subtype and clinical or pathologic stage. Molecular subtypes are alternatively classified into five pathologic subtypes based on immunohistochemical staining: luminal A, luminal B (HER2-negative), luminal B (HER2-positive), HER2-enriched, and triple-negative.

Perioperative treatment regimens are broadly categorized as endocrine therapy alone for luminal A tumors; endocrine therapy and chemotherapy for luminal B (HER2-negative) tumors; endocrine therapy, chemotherapy, molecular targeted therapy, and antibody–drug conjugates (ADCs) for luminal B (HER2-positive) tumors; and chemotherapy, molecularly targeted therapy, and ADCs for HER2-enriched or triple-negative tumors. Molecularly targeted therapies include anti-HER2 antibodies and immune checkpoint inhibitors. The antibody–drug conjugate is T-DM1. In addition to these treatment regimens, guidelines recommend the addition of CDK4/6 inhibitors, capecitabine, TS-1 (indicated in Japan only), and PARP inhibitors (in the presence of germline BRCA1/2 mutations) based on the degree of response to neoadjuvant therapy (e.g., the presence or absence of pCR).

Within this highly segmented treatment regimen, it would be useful to consolidate and organize discussion according to the five molecular subtypes mentioned above, focusing on the neoadjuvant setting followed by response-guided therapy. We believe that there is an important need for evidence-based review articles, articles providing real-world data, including on specific issues in actual clinical practice, and introductory articles on the latest clinical trials.

Prof. Dr. Hiroyuki Takei
Dr. Takaaki Fujii
Guest Editors

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Keywords

  • neoadjuvant systemic therapy
  • chemotherapy
  • endocrine therapy
  • molecular targeted therapy
  • molecular subtypes
  • response-guided therapy
  • clinical trials

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Related Special Issue

Published Papers (1 paper)

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Review

32 pages, 3553 KB  
Review
Axillary De-Escalation After Neoadjuvant Therapy in cN2/N3 HER2-Positive and Triple-Negative Breast Cancer: Navigating Biological Promise and Clinical Uncertainty
by Kefah Mokbel, Ibrahim Abugheida, Janhavi Venkataraman and Humaid O. Al-Shamsi
Cancers 2026, 18(18), 2986; https://doi.org/10.3390/cancers18182986 - 15 Sep 2026
Abstract
Axillary de-escalation after neoadjuvant systemic therapy (NST) is established in cN1 breast cancer, but the trials validating sentinel lymph node biopsy (SLNB), targeted axillary dissection (TAD) and omission of regional nodal irradiation (RNI) largely excluded cN2/N3 disease. In HER2-positive and triple-negative disease, NST [...] Read more.
Axillary de-escalation after neoadjuvant systemic therapy (NST) is established in cN1 breast cancer, but the trials validating sentinel lymph node biopsy (SLNB), targeted axillary dissection (TAD) and omission of regional nodal irradiation (RNI) largely excluded cN2/N3 disease. In HER2-positive and triple-negative disease, NST achieves axillary pathological complete response (pCR) in about one-third of cN2/N3 patients and 70–80% of those achieving breast pCR—establishing biological plausibility, not technical or trial-validated eligibility. The prospective evidence base comprises 87 patients evaluated against completion axillary lymph node dissection (cALND), only 41 informative for false-negative rate. Much of this evidence is defined by node count rather than by matting or fixation, so it applies directly to patients with more than three suspicious but mobile nodes—AJCC cN1 by fixation criteria, but sharing the same multi-node technical problem—while being correspondingly less confined to AJCC-defined cN2/N3 than the label implies. Across non-randomised cohorts, no oncological penalty has emerged after de-escalation in selected responders, though only three supply an axillary-recurrence numerator confined to advanced nodal disease. Within these limits, omission of cALND may reasonably be offered to selected excellent responders with cN2a or level I/II-predominant disease and TAD-confirmed nodal pCR, provided RNI is retained, and the decision is multidisciplinary-team supported and documented. Omitting RNI as well rests on extrapolation from NSABP B-51/RTOG 1304, which excluded this population, and should remain within prospective evaluation, as should cALND omission for residual disease. Level I/II TAD/SLNB does not sample the compartments defining cN2b, cN3a, or cN3c disease and samples only the axillary component of cN3b disease, which cALND does not sample either; comprehensive RNI remains indicated in these subgroups. In cN2b, the axilla is clinically uninvolved, so cALND is not required, and axillary staging by SLNB alone is appropriate. cN2/N3-specific validation of false-negative rate and outcomes remains the priority. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy of Breast Cancer: 2nd Edition)
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