Neoadjuvant Chemotherapy and Targeted Therapies: a Promising Strategy

Neoadjuvant therapy in breast cancer has emerged as an important setting for the development of targeted drugs. Because tumor material is available before treatment, at the moment of surgery, and possibly during treatment, precise correlations can be made between target identification, target blockade, and tumor response. Significant improvements have already been achieved by introducing targeted agents to neoadjuvant modalities. In the HER2 patient population, anti-HER2 targeted therapies have consistently demonstrated increased rates of pathological complete response. In the hormone receptor–positive setting, identifying early surrogate markers able to predict response to treatment has the potential to accelerate the development of targeted therapies. Ongoing neoadjuvant research programs such as NeoBIG and I-SPY 2 (Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging And moLecular Analysis 2) are scientifically strong and will most likely demonstrate that the ”neoadjuvant step” can lead directly to large, phase III adjuvant registration trials. This implies that the time between drug discovery and regulatory approval can be significantly shortened, which ultimately benefits patients.