Neoadjuvant chemotherapy for locally advanced breast cancer: A review of the literature and future directions • J. Mathewa, • K.S. Asgeirssona, • K.L. Cheunga, • S. Chanb, • A. Dahdab, • J.F.R. Robertsona • a Professorial Unit of Surgery, Nottingham University Hospital (City hospital Campus), Hucknall Road, Nottingham NG5 1PB, UK • b Department of Clinical Oncology, Nottingham University Hospital (City hospital Campus), Nottingham, UK European Journal of Surgical Oncology (EJSO).Volume 35, Issue 2, February 2009, Pages 113–122 Abstract Background Most patients with locally advanced primary breast cancer have micrometastases at the time of presentation. Randomised trials on the use of neoadjuvant chemotherapy have not been carried out specifically in a population of breast cancer patients with locally advanced disease (LAPC). Despite this, its use for cytoreduction in these patients is an established option which may facilitate excision of the primary tumour and local lymph node metastasis for local control. Significant improvements in local disease control have been seen with recent advances in systemic chemotherapy regimens although thus far this has not shown in randomised trials to translate into overall survival benefits. Methods In this review, all studies where a large proportion (approximately 70%) of included patients with LAPC, were selected. A search of Medline and PubMed databases was performed. Specifically, the different chemotherapy regimens and their relation to oncological outcomes was assessed. Results and conclusion The studies assessed were heterogeneous with regard to patient selection and chemotherapy regimens used. A complete pathological response is the strongest predictor of disease-free and overall survival. Recent studies on the use of targeted biological therapies in addition to chemotherapy suggest that rates of complete pathological response may be significantly increased when compared to chemotherapy alone. Furthermore, improvements in localisation and imaging techniques, used in conjunction with the increasing use of oncoplastic breast-conserving techniques, highlight the possibility that a subgroup of these patients may safely be treated with breast conservation. Keywords Locally advanced primary breast cancer; Neoadjuvant chemotherapy; Clinical response; Pathological response; Oncoplastic conservation surgery Neoadjuvant chemotherapy for locally advanced breast cancer: a review of the literature and future directions. Mathew J, Asgeirsson KS, Cheung KL, Chan S, Dahda A, Robertson JF. Eur J Surg Oncol. 2009 Feb;35(2):113-22. doi: 10.1016/j.ejso.2008.03.015. Epub 2008 May 23. Source Professorial Unit of Surgery, Nottingham University Hospital, Nottingham, UK. mathewjohn9@aol Abstract BACKGROUND: Most patients with locally advanced primary breast cancer have micrometastases at the time of presentation. Randomised trials on the use of neoadjuvant chemotherapy have not been carried out specifically in a population of breast cancer patients with locally advanced disease (LAPC). Despite this, its use for cytoreduction in these patients is an established option which may facilitate excision of the primary tumour and local lymph node metastasis for local control. Significant improvements in local disease control have been seen with recent advances in systemic chemotherapy regimens although thus far this has not shown in randomised trials to translate into overall survival benefits. METHODS: In this review, all studies where a large proportion (approximately 70%) of included patients with LAPC, were selected. A search of Medline and PubMed databases was performed. Specifically, the different chemotherapy regimens and their relation to oncological outcomes was assessed. RESULTS AND CONCLUSION: The studies assessed were heterogeneous with regard to patient selection and chemotherapy regimens used. A complete pathological response is the strongest predictor of disease-free and overall survival. Recent studies on the use of targeted biological therapies in addition to chemotherapy suggest that rates of complete pathological response may be significantly increased when compared to chemotherapy alone. Furthermore, improvements in localisation and imaging techniques, used in conjunction with the increasing use of oncoplastic breast-conserving techniques, highlight the possibility that a subgroup of these patients may safely be treated with breast conservation. Predictive and prognostic factors in locally advanced breast cancer: effect of intratumoral FOXP3+ Tregs • Lutfiye Demir, • Seyran Yigit, • Hulya Ellidokuz, • Cigdem Erten, • Isil Somali, • Yuksel Kucukzeybek, • Ahmet Alacacioglu, • Suna Cokmert, • Alper Can, • Murat Akyol, • … Clinical & Experimental Metastasis July 2013 Abstract This study aimed to investigate the prognostic and predictive effect of FOXP3+ Tregs together with clinicopathologic factors in locally advanced breast cancer (LABC) patients. The medical records of 101 LABC patients who received neoadjuvant chemotherapy (NAC) between 2005 and 2012 were evaluated retrospectively. The density of intratumoral FOXP3+ lymphocytes in paraffin-embedded tissues was assessed by immunohistochemical analyses in appropriate cases. The relationship with clinicopathologic features, prognosis and chemotherapy response was investigated. HR(–) and HER2(+) tumors tended to have higher pre-chemotherapy Tregs than HR(+) tumors, and significantly higher pathologic complete response (PCR) rates were observed in these patients. Treg decline after NAC was associated with better pathological response rates. Lower intratumoral infiltration of FOXP3+ Tregs after NAC (
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