>>> DR.
JAY K. HARNESS: I often find myself in an interesting discussion with patients about
adjuvant versus neoadjuvant chemotherapy.
Now, my medical oncologist colleague, Dr. David Margileth, has discussed on our breast
cancer answers web site the difference between adjuvant and neoadjuvant chemotherapy.
Quite briefly, adjuvant chemotherapy is given after surgery as an adjunct to the surgery
and is part of the systemic treatment, the whole body treatment of breast cancer.
The term neoadjuvant chemotherapy means upfront chemotherapy.
I am often asked the question, “Dr. Harness, is one of these better than the other?”,
and the answer is “No”.
It isn’t a question of what’s being better than the other.
We would never make, or certainly I would nor my colleagues, ever make a recommendation
where something is less than.
Now, from my perspective as a full time breast surgeon, neoadjuvant chemotherapy is really
helpful in a variety of circumstances.
Let me give you several examples: Number one, a patient presents with a really large
breast cancer even doing a mastectomy would not be possible.
These are typically what we call locally advanced breast cancers.
So we go ahead and do the chemotherapy, the neoadjuvant chemotherapy, as a way of reducing
down the size of the cancer so that we can eventually operate, including, if we have
to do a mastectomy.
Another advantage is we have got a cancer that is sort of borderline, as far as the
patient being eligible for breast conservation or not, patients highly motivated for breast
conservation.
We know that the neoadjuvant chemotherapy is going to shrink the cancer.
What we don’t know upfront is by how much.
In HER-2/neu positive breast cancers, particularly those that are one and half centimeters or
larger in patients highly motivated for a breast conservation, I almost always recommend
neoadjuvant chemotherapy because in the HER2/neu breast cancers, the response to that upfront
chemotherapy can be quite dramatic.
In fact, there is a significant percentage of time that the cancer will actually pathologically
disappear in the breast.
Another advantage, if you will, of neoadjuvant chemotherapy is that it tells something about
the biology of the cancer.
If there is a really good response or complete pathologic response, the patient may do better.
Now, this is a debatable subject.
There are those that say, “Gee, there is no difference in survival”, but in those
who have complete pathologic response, cancer disappears completely pathologically when
you operate in the breast and remove the area where the cancer was in.
Prove that it is gone, and that sub-category of patients, most of those patients in fact,
do better.
So it isn’t a question that one is better than the other.
Everything again that we do has advantages and disadvantages.
I have tried to highlight to you my thoughts as a full-time breast surgeon about when I
think neoadjuvant chemotherapy is important.
Please also listen to and watch Dr. David Margileth description of adjuvant versus neoadjuvant
chemotherapy and the definition of these two.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
Coree: I am a breast cancer survivor.
Susan Denver: And I want every woman to know…
Katherine Stockton: …about personalized breast cancer treatment…
Susan Denver: …and the genomic test.
Coree: A test that helps guide a woman and her doctor…
Katherine Stockton: …to the best treatment options for her.
Susan Denver: Pass it on!