Neoadjuvant chemotherapy for breast cancer - Time to rethink. 27Jul22

Rethinking Neoadjuvant Chemotherapy for breast cancer- Prof Jayant Vaidya Chapters 00:00 BMJ paper: Rethinking neoadjuvant chemotherapy for breast cancer? 01:30 Chemotherapy in perspective 02:00 Why give (or not give) neoadjuvant chemotherapy? 04:13 Clinical trial results showing no-benefit and worse for local recurrencefrom neoadjuvant chemotherapy 04:48 The lack of survival benefit (vs adjuvant therapy) despite higher pCR rate 10:11 Neoadjuvant chemotherapy could be dangerous 12:26 Improving pCR does not improve breast conserving surgery rate 14:26 Problems with using KATHARINE trial data to justify NACT for HER2 positive breast cancer. Given the issues about PCR (   • The folly of faith in Pathological Complet...  ) - TDM-1 may benefit those with 'PCR' too - and Katherine trial excluded those with 'PCR' and 20% of them died and then Problems with using CREATE-X trial to justify NACT for triple negative breast cancer Original BMJ paper is at https://www.bmj.com/content/360/bmj.j... Full paper is available at http://discovery.ucl.ac.uk/10041365/ Full paper + Discussion is available at http://bit.ly/nactbmj2018full The BMJ Podcast   / neoadjuvant-treatment-for-breast-cancer-no...   Key messages Neoadjuvant chemotherapy is being increasingly used for breast cancer despite higher rates of local recurrence and no evidence of survival benefit, mainly because of the immediate and dramatic pathological responses seen with newer drugs The increased pathological response of the primary tumour in the breast does not translate into a survival benefit even when given in the adjuvant setting, challenging the paradigm of “window of opportunity” studies We must acknowledge that neoadjuvant chemotherapy may not be beneficial to breast cancer patients We should consider reducing the widespread use of neoadjuvant chemotherapy