Issues involved in research into the neoadjuvant treatment of breast cancer

Randomized studies have failed to find convincing evidence that neo-adjuvan t chemotherapy results in improved overall survival,This may be related to limited efficacy of the regimens used. A sequence of an anthracycline-based primary chemotherapy followed by docetaxel has shown promising results whi ch are briefly discussed,The assessment of the efficacy of neoadjuvant ther apy should be based on the evaluation of pathological response and a simple , reproducible method of grading differential response would be of great va lue. Positive identification of tumor stroma is essential in defining patho logical complete response (pCR). This paper presents a grading scheme based purely on microscopic assessment which classifies patients into five group s with significantly different disease-free and overall survival. A system dividing patients into only two groups, i.e. those with pCR or those with a ny evidence of invasive tumor, may lose information of prognostic value. As sessing the response of metastatic disease in the lymph nodes, as well as r esponse of the primary tumor, may further refine our ability to identity th ose patients likely to gain most from neoadjuvant chemotherapy. [(C) 2000 L ippincott Williams & Wilkins].