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Annals of Oncology Advance Access originally published online on August 2, 2005
Annals of Oncology 2005 16(9):1407-1410; doi:10.1093/annonc/mdi288
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© 2005 European Society for Medical Oncology

Editorial

‘Small’ randomised neo-adjuvant chemotherapy trials in breast cancer reporting on pathological response: more harm than good?

H. Bonnefoi

Department of Gynaecology and Department of Medicine, Breast and Gynaecological Oncology Medical Unit, Hôpitaux Universitaires de Genève, 30 Boulevard de la Cluse, 1211 Genève 14, Switzerland

(Email: Herve.Bonnefoi@hcuge.ch)

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The main clinical advantage of neo-adjuvant chemotherapy in operable breast cancer is that it has improved the ability to perform breast-conserving therapy. In addition, it can be considered as an ideal model for studying chemosensitivity in vivo [1Go]. Observations from early studies, both single arm phase II studies and those randomising pre-operative systemic therapy against post-operative adjuvant therapy, have confirmed that those women whose tumours have a pathological complete response to neo-adjuvant chemotherapy have the best long-term outcome, and this remains true after multivariate analysis [2Go, 3Go]. Therefore, pathological complete response is now considered as a surrogate for survival and since the mid-1990s, clinicians have made this a primary or secondary end point in randomised trials of pre-operative chemotherapy. It has even been suggested that regimens achieving a higher proportion of patients in pathological complete response should then be used in the adjuvant setting as they must . . . [Full Text of this Article]


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