Post-neoadjuvant strategies in breast cancer: From risk assessment to treatment escalation

Giacomo Pelizzari, Lorenzo Gerratana, Debora Basile, Valentina Fanotto, Michele Bartoletti, Alessia Liguori, Caterina Fontanella, Simon Spazzapan, Fabio Puglisi

Research output: Contribution to journalReview articlepeer-review


The post-neoadjuvant setting in early breast cancer represents an attractive scenario for adjuvant clinical trials, offering the opportunity to test new drugs or combinations in high-risk patients who did not achieve pathologic complete response after primary treatment. No standard therapies are routinely proposed to patients with residual disease after neoadjuvant chemotherapy and few trials have explored this setting. To date, only one randomized phase III study showed the benefit of additional capecitabine after neoadjuvant chemotherapy, and international guidelines recommend at least to consider its use, particularly for triple negative breast cancer. Therefore, the management of these patients is still a clinical challenge, with limited data supporting the use of an additional adjuvant non-cross-resistant chemotherapy. Escalation strategies are currently under evaluation, with new agents proposed as supplementary post-neoadjuvant treatment (e.g. platinum salts, capecitabine, poly ADP-ribose polymerase inhibitors, immune checkpoint inhibitors, cyclin-dependent kinase 4/6 inhibitors). Based on these premises, selection criteria are critical to identify patients who may benefit from post-neoadjuvant therapies, through the validation of prognostic and predictive biomarkers for a reliable risk assessment and estimation of benefit. The present review summarizes the efforts in introducing new therapeutic options for patients with breast cancer and residual disease after neoadjuvant treatment, with a particular focus on the ongoing clinical trials and useful biomarkers for risk stratification.

Original languageEnglish
Pages (from-to)7-14
Number of pages8
JournalCancer Treatment Reviews
Publication statusPublished - Jan 1 2019


  • Breast cancer
  • pCR
  • Post-neoadjuvant treatment
  • Residual disease

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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