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Complete response confirmed by histopathological evaluation after neoadjuvant chemotherapy is a positive prognostic factor in some breast cancer subtypes. This marker is not of value in postmenopausal patients with ER/PR+ HER2�C tumors, who are candidates for neoadjuvant hormone therapy. These patients have a good prognosis if in a histopathological report after surgery there are features such as pT1, pN0, Ki67 Succimer current knowledge about preoperative pharmacotherapy of breast cancer. Keywords: preoperative systemic treatment, complete pathological response, breast cancer subtypes Introduction Chemotherapy, hormonal therapy and molecular targeted therapy are important elements of breast cancer treatment. Systemic treatment is indicated in patients with locally or regionally advanced cancer. It is also the basic treatment of metastatic breast cancer. In patients with operable breast cancer, preoperative chemotherapy has the same value as postoperative treatment regarding disease-free survival (DFS) and overall survival (OS) [1]. Primary systemic therapy plays the crucial role in treatment of patients with inoperable tumors (TNM stage III, excluding T3N1). Neoadjuvant therapy can induce a tumor response and enable CB-839 chemical structure radical surgery. This type of treatment is of value also in patients with primary operable cancer, when after tumor shrinkage breast conserving surgery (BCS) becomes possible (T3N0-1). During the planning of systemic treatment it is important to consider not only the stage of the disease but also its biological character determining sensitivity of cancer cells to the medicaments. This paper is a review of the literature dedicated to the optimal preoperative systemic treatment in patients with breast cancer and presents current knowledge of the topic. Making a diagnosis According to the current guidelines of the European Society of Medical Oncology (ESMO) the goals of preoperative systemic treatment in patients with breast cancer are [2]: To enable breast conserving surgery in stage T3N0-1M0, To enable mastectomy in patients with primary inoperable breast cancer in stage IIIA�CC and inflammatory breast cancer (T1-4N0-3M0), To obtain information about efficacy of pharmacotherapy and prognosis, To broaden Gemcitabine supplier the knowledge about biology and optimal treatment of breast cancer (clinical trials). Before treatment an accurate diagnosis is essential. Information about histopathological type, receptor expression and staging should be obtained. Material for histopathological and immunohistochemical evaluation should be obtained from the tumor through core needle biopsy. A surgical specimen can also be taken. In the case of axillary lymphadenopathy, fine needle biopsy of the lymph nodes should be performed.
