If you or a loved one has been diagnosed with cancer, your care team may recommend chemotherapy, one of the most common types of cancer treatment available. Chemotherapy involves the use of medications that travel throughout the body with the intent of killing cancer cells and stopping further growth of a tumor. When this therapy is used prior to surgery, it is called neoadjuvant chemotherapy and is used to shrink the tumor prior to surgical removal.1
What Is Neoadjuvant Chemotherapy?
Neoadjuvant chemotherapy refers to chemotherapy that is given before surgery. The goal of neoadjuvant chemotherapy is to shrink the tumor or reduce its spread, making it easier to remove surgically, or to improve the success of the surgery by reducing the size of the cancer.
Here’s how it works in more detail:
- Tumor Shrinkage: The chemotherapy targets rapidly dividing cancer cells, reducing the size of the tumor or even eliminating cancer cells that may be harder to target with surgery alone, including cancer cells that have spread to the lymph nodes.
- Improved Surgical Outcome: By shrinking the tumor, neoadjuvant chemotherapy can make surgery easier, decrease the likelihood of needing extensive surgery (e.g., lumpectomy vs mastectomy), and may lower the risk of the cancer returning.
- Assessing Tumor Response: It also provides the care team with valuable information about how the cancer responds to the drugs, which can help to guide the treatment plan post-surgery.
The Difference Between Adjuvant and Neoadjuvant Chemotherapy
The main difference between adjuvant chemotherapy and neoadjuvant chemotherapy lies in the timing of the treatment relative to surgery.
As described above, neoadjuvant chemotherapy is given before surgery in order to shrink the tumor and hopefully improve surgical outcomes.
Adjuvant chemotherapy is given after surgery with the goal of eliminating any remaining cancer cells that may have been missed during surgery and to reduce the risk of cancer recurrence.
It is important to note that the established chemotherapy regimens and the amount of chemotherapy given is the same whether given in the adjuvant or neoadjuvant setting.
When Is Neoadjuvant Chemotherapy Used?
Neoadjuvant chemotherapy is most often used when the tumor is too big to remove upon initial diagnosis; if the cancer has spread to the lymph nodes; or in the treatment of inflammatory or other aggressive forms of breast cancer that are known to respond well to chemotherapy.2
Not all patients are eligible to receive neoadjuvant chemotherapy. Factors involved in the decision to use this therapy include:
- Type of cancer
- Stage of cancer
- Size of tumor
- Location of tumor
- Patient’s overall health
- Patient’s underlying medical condition(s)
Administration of Neoadjuvant Chemotherapy for Breast Cancer
Chemotherapy is most often given through an IV. The regimens can be every two weeks or three weeks for a total duration of 3-6 months, but this timeline can vary based on individual factors and tumor responses.2
The number of neoadjuvant chemotherapy cycles will vary from patient to patient and will be based on individual factors, such as tumor size, stage, receptor status, and response to the first few cycles of chemotherapy. The care team will also take into consideration other factors including the health of the patient, surgical considerations, and multidisciplinary team recommendations.
Because of the nuances of individualized care and monitoring of side effects and response, it is important for patients undergoing neoadjuvant chemotherapy to stay in close contact with their care team throughout the duration of treatment.
Final Thoughts Regarding Neoadjuvant Chemotherapy
If you have been diagnosed with breast cancer, it’s important to maintain close contact with your care team to under the best treatment options based on the unique characteristics of your tumor. If it’s determined that neoadjuvant chemotherapy is appropriate for you, this therapy can be a powerful tool in the treatment of breast cancer, leading to better surgical and long-term survival outcomes.
Sources:
- National Cancer Institute. Definition of Neoadjuvant Therapy.
- American Cancer Society. Chemotherapy for Breast Cancer.
