Neoadjuvant Therapy

Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole

This will completely depend on the type of tumor. Some of the more aggressive cancers actually respond best to chemotherapy as neoadjuvant treatment, while some of the less aggressive tumors may respond better to anti-estrogen therapy (tamoxifen or an aromatase inhibitor). Tumors that over-express Her2/neu will often respond best to a combination of chemotherapy and herceptin. Newer molecular profiling tests that are done on the breast cancer (MammaPrint and Oncotype Dx) can give us some very helpful information regarding the aggressiveness of a cancer as well as the potential for response to different therapies. Each case is really individualized, and we are now more than ever better able to tailor a particular regimen to a patient's individual cancer for the best results. This will completely depend on the type of tumor. Some of the more aggressive cancers actually respond best to chemotherapy as neoadjuvant treatment, while some of the less aggressive tumors may respond better to anti-estrogen therapy (tamoxifen or an aromatase inhibitor). Tumors that over-express Her2/neu will often respond best to a combination of chemotherapy and herceptin. Newer molecular profiling tests that are done on the breast cancer (MammaPrint and Oncotype Dx) can give us some very helpful information regarding the aggressiveness of a cancer as well as the potential for response to different therapies. Each case is really individualized, and we are now more than ever better able to tailor a particular regimen to a patient's individual cancer for the best results.

Neoadjuvant therapy refers to chemotherapy or anti-estrogen therapy administered before surgery - usually in an attempt to decrease the size of the tumor. One situation where neoadjuvant therapy is helpful is if the tumor is too large to remove with lumpectomy and still leave an acceptable cosmetic result - neoadjuvant therapy can shrink the tumor to allow for a more cosmetic lumpectomy. Another situation when neoadjuvant therapy is used is if the tumor is already invading into the skin or muscle - it can be very difficult to perform surgery in these situations, so often chemotherapy will be used prior to surgery.

It is important to realize that in cases where neoadjuvant therapy is given, tumors do not always shrink concentrically - in other words, they sometimes shrink in some areas but leave little pockets of cancer cells behind. For that reason if I have a patient undergoing neoadjuvant therapy, I will often obtain an MRI prior to surgery to make as sure as possible that we are not dealing with a situation where there are multiple pockets of cancer cells remaining. Neoadjuvant therapy refers to chemotherapy or anti-estrogen therapy administered before surgery - usually in an attempt to decrease the size of the tumor. One situation where neoadjuvant therapy is helpful is if the tumor is too large to remove with lumpectomy and still leave an acceptable cosmetic result - neoadjuvant therapy can shrink the tumor to allow for a more cosmetic lumpectomy. Another situation when neoadjuvant therapy is used is if the tumor is already invading into the skin or muscle - it can be very difficult to perform surgery in these situations, so often chemotherapy will be used prior to surgery.

It is important to realize that in cases where neoadjuvant therapy is given, tumors do not always shrink concentrically - in other words, they sometimes shrink in some areas but leave little pockets of cancer cells behind. For that reason if I have a patient undergoing neoadjuvant therapy, I will often obtain an MRI prior to surgery to make as sure as possible that we are not dealing with a situation where there are multiple pockets of cancer cells remaining.