Neoadjuvant chemotherapy: for whom?

Initially, neoadjuvant chemotherapy (NAC) was used in inflammatory breast cancers and inoperable tumors. More recently, indications have been spread to earlier stages and operable breast cancers. No effect on overall survival has been demonstrated. The benefits of NAC include an increase in the conservative surgical treatment rate and improved aesthetic results. NAC allows the evaluation of chemosensitivity through the pathological complete response (pCR), predictive factor for better prognostic. Response to NAC is linked to tumor biology, and oncoplastic surgery can be an alternative to NAC. A multidisciplinary assessment is needed for optimal management of these patients.