Neoadjuvant Therapy of Breast Cancer

Dear Colleagues,

Perioperative systemic therapy for operable breast cancer is subdivided according to the molecular subtype and clinical or pathologic stage. Molecular subtypes are alternatively classified into five pathologic subtypes based on immunohistochemical staining, such as 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).

In this highly segmented treatment regimen, it would be useful to consolidate and organize the 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, real-world data articles including 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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