Recenti progressi nel trattamento medico del carcinoma della mammella

Neoadjuvant (preoperative) chemotherapy is a therapeutic choice in operable locally advanced breast carcinoma. It is administered with the aim of obtaining several advantages: to increase conservative surgery, which becomes possible in 82-95% of cases, to reduce local recurrences and to prolong overall survival. Hormone therapy and chemotherapy added to local radical treatment favorably alter the natural history of breast cancer: randomized trials have indicated that the reduction in recurrence and death rates is statistically significant for pre- and post-menopausal women. The reduction in recurrence rate is of 35 and 20% respectively in women <50 years and in older women. The reduction in mortality rate is 27 and 11% respectively in the same category. Guidelines for the adjuvant treatment has been better through the definition of different risk categories on the basis of prognostic factors, such as dimension of primitive, lymph node involvement, estrogen- and progesteron-receptor expression, and age. Ongoing trials should help verify if prognosis of lymph node negative patients could be improved by the use of anthracyclines in the adjuvant setting, as well as in lymph node positive patients. Regarding the treatment of metastatic disease, the availability of new drugs, like paclitaxel, docetaxel and vinorelbine, obtained good rates in terms of responses (50-80% and 40-60% in first and second line chemotherapy respectively), associated with a benefit in quality of life. Actually the clinical and biological research wants to identify the synergism between available drugs and new hormonal or cytotoxic molecules and to introduce new biological modulators of the response in the clinical practice.