Neo-Adjuvant Treatment for Breast Cancer

by Mary Kremer, CN-Bi, R.T. (R)(T) Certified Breast Cancer Navigator

Newer approach to breast cancer treatment for Her2 positive cancer

In the last several years there has been new management in the treatment of breast cancers that are Her2-neu positive. While examining the sample obtained during a breast biopsy, the pathologist evaluates for expression of a certain protein called Her2-neu, if the diagnosis is a breast cancer. Her2 or “human epidermal growth factor receptor 2” is a gene that helps control the growth and repair of cells.

This is a protein that appears on the surface of some breast cancer cells. Breast cancers that are Her2 positive have over-expression of the gene indicating that the gene is making too many copies of itself. Extra copies of Her2 genes tell breast cancer cells to grow and multiply. For most breast cancers, surgery is the first line of treatment. After healing of the surgical wound in about 4 – 6 weeks, then other forms of treatment tend to follow.

However, for Her2-neu positive cancers, the oncologists and surgeons may consider certain medications before surgery which is called neoadjuvant therapy. Two agents that have been used in neoadjuvant regiments are Herceptin and Perjeta. Treatment recommended after surgery is called adjuvant therapy.

A benefit of neoadjuvant treatment is that it prevents delay of administering chemotherapy to treat and prevent breast cancer spread beyond the breast, as it is given in these cases, before surgery. In patients who tend to heal slowly after having a lumpectomy or mastectomy, their treatments could be delayed, as doctors typically wait for the surgical wound to heal before administering chemotherapy.

Additionally, since neoadjuvant chemotherapy could shrink the size of cancer, the patient may now be able to have a lumpectomy with radiation, instead of a mastectomy, hence allowing breast conservation. Not every woman who has been diagnosed with a Her2 positive breast cancer may require neoadjuvant treatment.

There are many factors that the medical team considers before deciding on a course of treatment. Doctors will take into consideration multiple different factors to decide on the appropriate regiment for treatment. Some of the factors may include age, overall performance status and other medical issues which could make some patients unable to tolerate potential side effects of certain treatments.

In summary, neoadjuvant chemotherapy is available in treating specific cases of breast cancer which are Her2-neu positive which allows shrinkage of the breast cancer and treatment of cancer beyond the breast, prior to surgery. This has additional benefits of changing surgical management from mastectomy to lumpectomy, which allows breast conservation. Recent advances in research have led to a patient-centered approach where treatment is tailored to each patient based on multiple relevant patient factors. 

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