Table of ContentsView AllTable of ContentsPurposeRisks and ContraindicationsBefore TherapyDuring TherapyAfter TherapyInterpreting the ResultsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Purpose
Risks and Contraindications
Before Therapy
During Therapy
After Therapy
Interpreting the Results
Frequently Asked Questions
Neoadjuvant therapy (NAT) refers to anysystemic treatment of breast cancer, such as chemotherapy, prior to surgical removal of a breast tumor. In addition to reducing the risk of recurrence, the goal of NAT is to shrink a breast cancer tumor so that local resection is possible. This is in contrast to adjuvant chemotherapy, which is administered after surgery to kill any remaining cancer cells.
Studies show that neoadjuvant chemotherapy increases the likelihood of getting breast conservation therapy (such aslumpectomy), reduces morbidity (medical problems), and results in a better self-image.
Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy.
This article will discuss what you need to know about preoperative chemotherapy cancer treatment and why it may be a good option for you.
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Purpose of Neoadjuvant Chemotherapy
All systemic therapy given for non-metastatic, invasive breast cancer is intended to reduce the risk of your cancer returning. But the purpose of administering it prior to surgery is to shrink your tumor or stop the spread of cancer to make surgery less invasive and more effective.
This process, called downstaging, may make it possible for you to have less extensive surgery on the breast and/oraxilla(armpit), especially for those with large tumors. By having the size of the tumor reduced, you may become a candidate for surgical resection or breast-conserving surgery rather thanmastectomy.
Neoadjuvant chemotherapy has also been shown to improve cosmetic outcomes and reduce postoperative complications such aslymphedema, particularly in those who undergo breast reconstruction surgery.
Up to half of the patients undergoing neoadjuvant treatment may become suitable candidates for breast conservation rather than mastectomy.
One systematic review of neoadjuvant chemotherapy for operable breast cancer found that those who received chemotherapy before surgery had a lower mastectomy rate than those undergoing some surgical procedure before being given chemotherapy.
In general, if you are a candidate for adjuvant systemic therapy, you are a candidate for neoadjuvant chemotherapy. Patients with tumors that are small (less than 2 centimeters), low grade, or ER-positive/Her2-negativemay not require systemic chemotherapy and therefore should undergo surgery first.
The people who benefit the most from NAT are:
A healthcare professional will perform aneedle biopsyof your breast cancer tumor before NAT. Once your tumor’s size, type, and extent are identified, you and your oncologist will determine the best course of action.
Most neoadjuvant chemotherapies are anthracycline- or taxane-based therapies. For HER2-positive tumors, neoadjuvant therapy usually includes a combination of chemotherapy and the HER2-targeted therapy drugsHerceptin (trastuzumab) and Perjeta (pertuzumab).
Chemotherapy and radiation may cause side effects like nausea, headache, vomiting, or fatigue. Fasting for a few days beforehand has been shown to limit these side effects.
Timing
If you are a candidate for NAT, you will likely start chemotherapy, radiation, or hormone therapy soon after your diagnosis. The average length of treatment is six to eight weeks, but it may be longer if you have more extensive disease.
The type of therapy that you use depends on the type of breast cancer you have. Doctors often use neoadjuvant chemotherapy as a way to see if your cancer will respond to a particular medication. If the cancer does not respond to that drug, your doctor will use other drugs for treatment, which may prolong your treatment course.
Location
NAT is usually administered in outpatient oncological centers or at the hospital. You will likely receive all your treatment at the same location.
What to Wear
You should dress comfortably for your NAT sessions. Loose clothing and comfortable shoes are suggested.
Food and Drink
You may eat and drink as you normally would before NAT, although some studies have shown that fasting for up to five days prior to therapy may protect you against the harmful side effects of chemotherapy or radiation therapy.
Cost and Health Insurance
The price of neoadjuvant therapy varies depending on the length of treatment needed and whether you have access to health insurance. For those with health insurance, the average cost is about $5,000.
What to Bring
Bring a list of the medications you are taking, identification, and your insurance card. Ask whether you will be able to use electronic devices such as your cell phone or an electronic book in the therapy room. Also, ask whether a support person can keep you company during the treatment.
Chemotherapy side effects can affect your judgment, motor skills, and vision in subtle ways, even in those who feel completely fine afterward. Fatigue and drowsiness are additional side effects that you may have to contend with.
Your doctor will likely suggest that you get a ride home after your chemotherapy appointments, whether from a family member, friend, or rideshare service like Uber or Lyft. Some clinics even offer transportation to and from appointments. Use your best judgment, especially if you are not feeling well.
During your appointment, you can expect the following:
Some people experience no side effects from chemotherapy while others experience side effects in the first few weeks afterward. Most chemotherapy symptoms usually last two to four weeks before resolving on their own.
More bothersome symptoms like nausea and vomiting can be treated with prescription or over-the-counter medications.
Neoadjuvant chemotherapy has some notable side effects, including:
Most chemotherapy side effects are temporary and disappear once your treatment is over. But some might take months or even years to go away completely, a phenomenon called late effects.
In rare cases, neoadjuvant chemotherapy can causelong-term damageto the heart, lungs, kidneys, or reproductive organs. But this is usually not the case because NAT is typically administered for a short period of time.
When to Call Your DoctorSeek immediate medical attention if you experience any of the following after NAT: a fever (usually over 100.5 degrees Fahrenheit), chills, rash, unexplained bleeding or bruising, bloody stools or urine, or prolonged symptoms such as headaches, diarrhea, or vomiting.
When to Call Your Doctor
Seek immediate medical attention if you experience any of the following after NAT: a fever (usually over 100.5 degrees Fahrenheit), chills, rash, unexplained bleeding or bruising, bloody stools or urine, or prolonged symptoms such as headaches, diarrhea, or vomiting.
Side Effects of Chemotherapy
Neoadjuvant therapy may shrink the tumor so much that a pathologist can’t find any remaining cancer, called a pathologic complete response (pCR). This does not mean that your cancer will never return, but it does mean that you may be eligible for less invasive and more cost-effective treatment options like lumpectomy versus mastectomy.
The rates of pCR after neoadjuvant chemotherapy are highest among people with tumors that are:
Summary
A person with breast cancer may receive neoadjuvant chemotherapy before surgery to remove the tumor. The goal is to shrink the tumor and reduce or prevent its spread. However, it is not appropriate for all people with breast cancer.
Neoadjuvant chemotherapy may result in being able to have a lumpectomy or other breast-conservation therapy rather than a mastectomy. It may also reduce other complications. As it is chemotherapy, it comes with a range of side effects.
A Word From Verywell
Neoadjuvant chemotherapy designed to be used before surgical removal of a tumor has received significant attention as an entry point for personalized medicine.
Not only does neoadjuvant chemotherapy offer the advantage of downstaging breast cancer, and therefore potentially reducing the extent of surgery, but, in an era of individualization of therapy, it also allows doctors to test the efficacy of new therapies.
The preoperative setting is a great time to study the activity of novel agents or therapy because they work better in cancers in their early or intermediate stages and it avoids the issue of adaptive resistance.
What is the goal of neoadjuvant therapy for breast cancer?
The goal of administering neoadjuvant chemotherapy is to shrink the tumor or stop the spread of cancer, making surgery less invasive and more effective. This process, called downstaging, reduces the size of your breast tumor, making surgical resection possible or making you a candidate for breast-conserving surgery rather than mastectomy.
There are several other advantages of neoadjuvant chemotherapy, including:
How effective is neoadjuvant chemotherapy for breast cancer?
Up to half of the patients undergoing neoadjuvant treatment may become suitable for breast conservation rather than mastectomy. Still, studies have shown little or no evidence of increased life expectancy with neoadjuvant chemotherapy versus adjuvant chemotherapy.
Which neoadjuvant therapy is right for me?
Neoadjuvant hormone therapy is mainly used to treat hormone receptor-positive (ER-positive and/or PR-positive) breast cancers, but the breadth of NAT use has expanded in recent years. If you are newly diagnosed with breast cancer, discuss the pros and cons of NAT with your doctor.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Masood S.Neoadjuvant chemotherapy in breast cancers.Womens Health (Lond). 2016;12(5):480-491. doi:10.1177/1745505716677139Woeste MR, Bhutiani N, Donaldson M, McMasters KM, Ajkay N.Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery.J Surg Oncol. 2021 Feb;123(2):439-445. doi:10.1002/jso.26301Thompson AM, Moulder-Thompson SL.Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324Mieog JSD, van der Hage Ja, van de Velde CJH.Neoadjuvant chemotherapy for opérable breast cancer.Br J Surg. 2007;94:1198–1200. doi:10.1002/bjs.5894National Comprehensive Cancer Network (NCCN).NCCN Clinical practice guidelines in oncology: Breast cancer V.1.2021.University of California San Francisco Osher Center for Integrative Medicine.Cancer and fasting / calorie restriction.Safdie F, Brandhorst S, Wei M, et al.Fasting enhances the response of glioma to chemo- and radiotherapy.PLoS One. 2012;7(9):e44603. doi:10.1371/journal.pone.0044603Zdenkowski N, D’Silva SM, Lawson K, Reeves P, Boyle FM.Economic evaluation of neoadjuvant chemotherapy for operable breast cancer.JCO. 2020;38(15_suppl):e12637-e12637. doi:10.1200/JCO.2020.38.15_suppl.e12637Li XB, Krishnamurti U, Bhattarai S, et al.Biomarkers predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer.Am J Clin Pathol. 2016 Jun;145(6):871-8. doi:10.1093/ajcp/aqw045BC Cancer.Neoadjuvant therapy.Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Masood S.Neoadjuvant chemotherapy in breast cancers.Womens Health (Lond). 2016;12(5):480-491. doi:10.1177/1745505716677139Woeste MR, Bhutiani N, Donaldson M, McMasters KM, Ajkay N.Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery.J Surg Oncol. 2021 Feb;123(2):439-445. doi:10.1002/jso.26301Thompson AM, Moulder-Thompson SL.Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324Mieog JSD, van der Hage Ja, van de Velde CJH.Neoadjuvant chemotherapy for opérable breast cancer.Br J Surg. 2007;94:1198–1200. doi:10.1002/bjs.5894National Comprehensive Cancer Network (NCCN).NCCN Clinical practice guidelines in oncology: Breast cancer V.1.2021.University of California San Francisco Osher Center for Integrative Medicine.Cancer and fasting / calorie restriction.Safdie F, Brandhorst S, Wei M, et al.Fasting enhances the response of glioma to chemo- and radiotherapy.PLoS One. 2012;7(9):e44603. doi:10.1371/journal.pone.0044603Zdenkowski N, D’Silva SM, Lawson K, Reeves P, Boyle FM.Economic evaluation of neoadjuvant chemotherapy for operable breast cancer.JCO. 2020;38(15_suppl):e12637-e12637. doi:10.1200/JCO.2020.38.15_suppl.e12637Li XB, Krishnamurti U, Bhattarai S, et al.Biomarkers predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer.Am J Clin Pathol. 2016 Jun;145(6):871-8. doi:10.1093/ajcp/aqw045BC Cancer.Neoadjuvant therapy.Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Masood S.Neoadjuvant chemotherapy in breast cancers.Womens Health (Lond). 2016;12(5):480-491. doi:10.1177/1745505716677139Woeste MR, Bhutiani N, Donaldson M, McMasters KM, Ajkay N.Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery.J Surg Oncol. 2021 Feb;123(2):439-445. doi:10.1002/jso.26301Thompson AM, Moulder-Thompson SL.Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324Mieog JSD, van der Hage Ja, van de Velde CJH.Neoadjuvant chemotherapy for opérable breast cancer.Br J Surg. 2007;94:1198–1200. doi:10.1002/bjs.5894National Comprehensive Cancer Network (NCCN).NCCN Clinical practice guidelines in oncology: Breast cancer V.1.2021.University of California San Francisco Osher Center for Integrative Medicine.Cancer and fasting / calorie restriction.Safdie F, Brandhorst S, Wei M, et al.Fasting enhances the response of glioma to chemo- and radiotherapy.PLoS One. 2012;7(9):e44603. doi:10.1371/journal.pone.0044603Zdenkowski N, D’Silva SM, Lawson K, Reeves P, Boyle FM.Economic evaluation of neoadjuvant chemotherapy for operable breast cancer.JCO. 2020;38(15_suppl):e12637-e12637. doi:10.1200/JCO.2020.38.15_suppl.e12637Li XB, Krishnamurti U, Bhattarai S, et al.Biomarkers predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer.Am J Clin Pathol. 2016 Jun;145(6):871-8. doi:10.1093/ajcp/aqw045BC Cancer.Neoadjuvant therapy.Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324
Masood S.Neoadjuvant chemotherapy in breast cancers.Womens Health (Lond). 2016;12(5):480-491. doi:10.1177/1745505716677139
Woeste MR, Bhutiani N, Donaldson M, McMasters KM, Ajkay N.Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery.J Surg Oncol. 2021 Feb;123(2):439-445. doi:10.1002/jso.26301
Thompson AM, Moulder-Thompson SL.Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324
Mieog JSD, van der Hage Ja, van de Velde CJH.Neoadjuvant chemotherapy for opérable breast cancer.Br J Surg. 2007;94:1198–1200. doi:10.1002/bjs.5894
National Comprehensive Cancer Network (NCCN).NCCN Clinical practice guidelines in oncology: Breast cancer V.1.2021.
University of California San Francisco Osher Center for Integrative Medicine.Cancer and fasting / calorie restriction.
Safdie F, Brandhorst S, Wei M, et al.Fasting enhances the response of glioma to chemo- and radiotherapy.PLoS One. 2012;7(9):e44603. doi:10.1371/journal.pone.0044603
Zdenkowski N, D’Silva SM, Lawson K, Reeves P, Boyle FM.Economic evaluation of neoadjuvant chemotherapy for operable breast cancer.JCO. 2020;38(15_suppl):e12637-e12637. doi:10.1200/JCO.2020.38.15_suppl.e12637
Li XB, Krishnamurti U, Bhattarai S, et al.Biomarkers predicting pathologic complete response to neoadjuvant chemotherapy in breast cancer.Am J Clin Pathol. 2016 Jun;145(6):871-8. doi:10.1093/ajcp/aqw045
BC Cancer.Neoadjuvant therapy.
Thompson AM, Moulder-Thompson SL. Neoadjuvant treatment of breast cancer.Ann Oncol. 2012;23 Suppl 10(Suppl 10):x231-x236. doi:10.1093/annonc/mds324
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