Neoadjuvant treatment in solid tumors—the earlier, the better in breast cancer

Systemic treatment is an essential part of medical care in patients with early breast cancer. Breast cancer subtypes differ in biological features and therefore require different therapeutic approaches: in triple-negative and HER2-positive breast cancers, neoadjuvant systemic treatment is standard of care. While taxane- and anthracycline-based chemotherapy is well established in triple-negative breast cancer, the addition of immune checkpoint inhibitors based on recent studies is becoming the new standard. In HER2-positive breast cancer, there is clear evidence for the use of neoadjuvant chemotherapy in combination with the HER2-antibodies trastuzumab and pertuzumab. In luminal cancers, neoadjuvant treatment is focused on downsizing to improve breast-conserving surgery. Besides chemotherapy, neoadjuvant endocrine therapy is another option in these usually endocrine-sensitive tumors. The review summarizes the rationale for neoadjuvant treatment in breast cancer and gives an overview of the current standard of care.