First things first.
More and more women are receiving neoadjuvant systemic therapy for breast cancer. Why? Because more and more high level data demonstrates that teasing out the poor responders and then tailoring further systemic therapy accordingly improves survival outcomes. Today we bring you the most recent guidelines on just who should receive neoadjuvant therapy. First up, any triple-negative clinically node-positive or primary tumor >1 cm should get upfront chemo with at least an anthracycline and taxane and perhaps also a platinum. Again, HER2+ clinically node-positive or primary tumor >1 cm should get upfront chemo with at least Taxol, carboplatin and trastuzumab and perhaps also pertuzumab. Of note, it explicitly recommends against neoadjuvant therapy for any cT1a-bN0. Finally, and only to potentially minimize surgery, hormone receptor-positive disease can receive upfront chemo when it would otherwise get it adjuvantly (e.g., clinical node positivity), and post-menopausal women may receive neoadjuvant endocrine therapy instead. | Korde, J Clin Oncol 2021