ABSTRACT
Neo-adjuvant chemotherapy (NACT) is the primary systemic treatment of breast cancer with chemotherapy (+/-HER2-targeted agents) prior to definitive surgery. This chapter addresses the indications for NACT, patient selection, and the different chemotherapy and systemic options available according to breast cancer subtype, as well as the relevance of pathological complete response (pCR) following NACT. We demonstrate how NACT can lead to improved surgical outcomes for patients and reduced mastectomy rates when used in combination with careful patient selection by a multidisciplinary team. A better understanding of intrinsic breast cancer subtypes, alongside more efficacious chemotherapy regimens and anti-HER2 therapy, has led to notable increases in pCR rates, and the degree of response to NACT may provide valuable prognostic information as well as to subsequent lines of direct treatment. Increasingly, the neo-adjuvant platform also provides important opportunities for research and drug development, and participation in clinical trials should be considered for eligible patients.
