Overview of adjuvant treatment in early breast cancer

Abstract

The benefits of adjuvant systemic therapy in reducing risk of distant relapse from breast cancer have been recognized for several de¬cades. The intent of adjuvant therapy is to eli¬minate the occult micrometastatic breast can¬cer burden before it progresses into clinically apparent disease. Decisions regarding adjuvant therapy are increasingly complex with the ad¬vent of new therapeutic strategies, a growing body of literature on the molecular biology and natural history of breast cancer, and ad¬vances in therapeutic techniques and early de¬tection. Systemic chemotherapy is an integral component of the adjuvant treatment strategy for women who have early-stage breast can¬cer and accounts for significant improvements in breast cancer-specific mortality. Endocri¬ne therapy plays a pivotal role in the early treatment of estrogen receptor (ER)-positive breast cancer. Successful delivery of effective adjuvant systemic therapy as a complement to surgical management of breast cancer has con¬tributed to the steady declines in breast can¬cer mortality observed internationally over the past 2 decades. Four large randomized trials to assess efficacy and toxicity of trastuzumab in adjuvant systemic therapy of breast cancer have been initiated. Results clearly demonstra¬te, that adjuvant treatment of trastuzumab sig¬nificantly improves outcomes for women with HER2 positive breast cancer.