10 MAY 2016

Neoadjuvant therapy for breast cancer

Contributed by: Dr Khoo Kei Siong

Survival rates for breast cancer have improved tremendously in recent years. Parkway Cancer Centre’s Dr Khoo Kei Siong gave an update to a group of doctors during a CME session.

In an effort to share information on the management and treatment of breast cancer, Parkway Cancer Centre hosted a Continuing Medical Education (CME) session with a group of 14 doctors from around Singapore. Dr Khoo Kei Siong, Deputy Medical Director at Parkway Cancer Centre, explained how neoadjuvant therapy has helped to improve survival rates globally and how Singapore can implement the therapy to give patients an improved rate of recovery.

Neoadjuvant therapy is treatment given before primary therapy, with the main aim of shrinking a tumour that is inoperable in its current state – so that it can be eventually removed surgically.

This treatment approach is typically used for breast, rectal (usually in combination with radiation therapy), ovarian and lung cancers, and is also an emerging treatment option in many other tumours.

For example, a woman with breast cancer may receive neoadjuvant therapy to shrink a tumour, enough to allow for breast-conserving surgery, instead of a mastectomy.

Dr Khoo stressed the importance of including neoadjuvant therapy in the overall management of breast cancer for two reasons – it facilitates surgery by reducing the size of the tumour and it helps to predict the risk of relapse according to the patient’s pathological response to the treatment.

Neoadjuvant therapy is typically administered orally or intravenously, during a number of cycles spanning a total treatment time of between three to six months.

Dr Khoo Kei Siong referred to several clinical studies conducted overseas that reported at least 50 per cent shrinkage in tumour size when neoadjuvant therapy was implemented.

In one special type of breast cancer, called HER2-positive breast cancer, several clinical trials have been performed to study whether using drugs that target HER2 receptors on these breast cancer cells may achieve better treatment outcomes. Lapatinib (Tykerb®), trastuzumab (Herceptin®), and pertuzumab (Perjeta®) are all HER2-targeting drugs that have been shown to increase the chance of shrinking tumour effectively before surgery.

During the short Q & A segment that followed, the audience of doctors held a lively discussion on mammograms and how best to encourage more women to start taking charge of their breast health. They also exchanged information on the viability of drugs typically used for chemotherapy in Singapore.

Written by Charmaine Ng

Benefits of neoadjuvant therapy

  • Converts inoperable breast cancer to an operable tumour
  • Increases breast conservation rates
  • May enable a response-adjusted treatment, reducing risk of relapse
POSTED IN Cancer Treatments
TAGS continuing medical education (CME), mammogram, mastectomy, neoadjuvant therapy