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Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The American Society of Breast Surgeons (ASBrS) sought to provide an evidence-based guideline on the use of neoadjuvant systemic therapy (NST) in the management of clinical stage II and III invasive breast cancer.

Methods

A comprehensive nonsystematic review was performed of selected peer-reviewed literature published since 2000. The Education Committee of the ASBrS convened to develop guideline recommendations.

Results

A performance and practice guideline was prepared to outline the baseline assessment and perioperative management of patients with clinical stage II–III breast cancer under consideration for NST.

Recommendations

Preoperative or NST is emerging as an important initial strategy for the management of invasive breast cancer. From the surgeon’s perspective, the primary goal of NST is to increase the resectability of locally advanced breast cancer, increase the feasibility of breast-conserving surgery and sentinel node biopsy, and decrease surgical morbidity. To ensure optimal patient selection and efficient patient care, the guideline recommends: (1) baseline breast and axillary imaging; (2) minimally invasive biopsies of breast and axillary lesions; (3) determination of tumor biomarkers; (4) systemic staging; (5) care coordination, including referrals to medical oncology, radiation oncology, plastic surgery, social work, and genetic counseling, if indicated; (6) initiation of NST; (7) post-NST breast and axillary imaging; and (8) decision for surgery based on extent of disease at presentation, patient choice, clinical response to NST, and genetic testing results, if performed.

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Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Los Angeles Center for Women’s Health, Los Angeles, CA, USA

    Dennis Holmes MD

  2. Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA

    A. Colfry MD

  3. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Brian Czerniecki MD

  4. Department of Surgery, Helen F. Graham Cancer Center, Newark, DE, USA

    Diana Dickson-Witmer MD

  5. Department of Surgery, Virginia Hospital Center, Arlington, VA, USA

    C. Francisco Espinel MD & Molly Sebastian MD

  6. Department of Surgery, Columbia University, New York, NY, USA

    Elizabeth Feldman MD

  7. Department of Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA

    Kristalyn Gallagher DO

  8. Department of Surgery, Duke University, Durham, NC, USA

    Rachel Greenup MD

  9. Department of Surgery, Washington University, St. Louis, MO, USA

    Virginia Herrmann MD

  10. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Henry Kuerer MD

  11. Department of Surgery, New York Hospital Queens, Flushing, NY, USA

    Manmeet Malik DO

  12. Department of Surgery, Hamilton Medical Center, Dalton, GA, USA

    Eric Manahan MD

  13. Arizona Associated Surgeons, Phoenix, AZ, USA

    Jennifer O’Neill MD

  14. Akron General Medical Center, Akron, OH, USA

    Mita Patel MD

  15. Department of Surgery, Stanford University, Palo Alto, CA, USA

    Amanda Wheeler MD

  16. Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Rena Kass MD

Authors
  1. Dennis Holmes MD
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  2. A. Colfry MD
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  3. Brian Czerniecki MD
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  4. Diana Dickson-Witmer MD
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  7. Kristalyn Gallagher DO
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  8. Rachel Greenup MD
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  9. Virginia Herrmann MD
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  10. Henry Kuerer MD
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  11. Manmeet Malik DO
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  12. Eric Manahan MD
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  13. Jennifer O’Neill MD
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  14. Mita Patel MD
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  15. Molly Sebastian MD
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  16. Amanda Wheeler MD
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  17. Rena Kass MD
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Corresponding author

Correspondence to Dennis Holmes MD.

Additional information

This journal article summarizes key factors that must be addressed in the care of the NST candidate. The full-length version of the guideline may be accessed at www.breastsurgeons.org.

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Holmes, D., Colfry, A., Czerniecki, B. et al. Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer. Ann Surg Oncol 22, 3184–3190 (2015). https://doi.org/10.1245/s10434-015-4753-3

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  • DOI: https://doi.org/10.1245/s10434-015-4753-3

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