Neoadjuvant treatment is routinely
used for certain breast, esophageal,
lung, stomach and rectal cancers, as
well as for some sarcomas. Nikesh
Jasani, an oncologist at the University
of Texas M.D. Anderson Cancer Center
in Houston, says it is typically used to
shrink the tumor, allowing the surgeon
to preserve all or parts of an organ
(for example, the oropharynx in those
with head and neck cancer), spare a
limb (such as in certain sarcomas), or
do a smaller surgery. In addition, in
some patients with highly aggressive
tumors, Jasani says, “you may have
better control of the tumor” if you give
chemotherapy before surgery.
When Nancy Touhill of Atlanta was
diagnosed in 2015 at age 33 with stage II
triple-negative breast cancer, she hadn’t
heard of neoadjuvant chemotherapy. But
her doctors wanted to see if they could
shrink her large tumor, she says.
Touhill had eight rounds of chemotherapy. The treatment worked,
contributing to her decision to have a
lumpectomy instead of a mastectomy.
Although she had post-surgery radiation,
Touhill did not need additional chemotherapy because there was no cancer
seen during the surgery. Her oncologist
told her this “complete pathological
response” was an indicator of a good
prognosis, she says.
Chemotherapy drugs were the first
treatments used in the neoadjuvant
setting. Today researchers are studying
other options. Cynthia Ma, a medical
oncologist at the Washington University
School of Medicine in St. Louis, for example, is leading a phase III trial of nearly
1,500 postmenopausal women with stage
II-III breast cancer to determine whether neoadjuvant Faslodex (fulvestrant),
an anti-estrogen drug approved to
treat metastatic breast cancer, or the
combination of Faslodex and Arimidex
(anastrozole), an anti-estrogen drug
used to treat early-stage breast cancer,
is better than Arimidex alone for shrinking breast tumors. The findings could
lead to new treatment options.
Treatment before surgery isn’t right
for every patient, Jasani says. He advises
FORWARD LOOK | BEYOND THE NEWS
Treatment Before Surgery
NEOADJUVANT THERAPY MAY BE AN OPTION
Many people assume surgery is the first step in cancer treatment. But for some patients, neoadjuvant therapy— chemotherapy, radiation therapy or hormone therapy given
before surgery—can be part of their cancer care.
A new study has raised concerns that neoadjuvant
chemotherapy could provide an avenue for
malignant breast tumor cells to spread to distant
sites. The study, led by researchers in New
York City at Einstein College of Medicine and
Montefiore Medical Center, was published on
July 5, 2017, in Science Translational Medicine.
The researchers studied breast cancer growth in
mice, as well as biopsy specimens from 20 women
who received Taxol (paclitaxel), Adriamycin
(doxorubicin) and Cytoxan (cyclophosphamide) before
surgery and did not have a full response—meaning
they still had tumor present at the time of surgery.
The study found that sites where three specific types of cells came into contact with one
another—known as a “tumor microenvironment
of metastasis” (TMEM)—served as entry points
for tumor cells to move into blood vessels
and be carried elsewhere in the body. Use of
chemotherapy drugs was associated with a higher
number of TMEM sites. Also, the higher the number
of TMEM sites, the more likely the tumors were
to metastasize, compared to tumors with fewer
While the study identified an “interesting
potential resistance mechanism,” there is no
foundation for concluding that Taxol causes
metastasis or that women should avoid neoadjuvant
chemotherapy, says Laura Esserman, a breast
oncologist at the University of California, San
Francisco, who was not involved in the study.
Esserman, who has conducted numerous
neoadjuvant clinical trials, notes that all the women
in the study had tumors that did not fully respond
to neoadjuvant chemotherapy. These tumors tend to
be more aggressive and more likely to metastasize,
which could influence the study’s findings. —D.C.
STUDY RAISES QUESTIONS
Cooling Cap Approved for More Cancer Types
The DigniCap Scalp Cooling System, which was approved in 2015 to help prevent hair loss
in breast cancer patients receiving chemotherapy, has had its use extended by the U.S.
Food and Drug Administration to include adult patients with any kind of solid tumor. The
DigniCap is used before, during and after a chemotherapy treatment to cool the scalp. The
cap is connected to a machine that regulates the cooling process.
LEARN MORE ON THE FDA WEBSI TE, FDA. GOV.
patients to ask their doctors whether
neoadjuvant treatment is an option and
if so, why it might be beneficial. “Every
cancer is different, and clear communication about treatment is the most important
thing,” Jasani says. —DARA CHADWICK
Gum Disease Associated with Higher Risk
of Some Cancers
An analysis of data collected through
the Women’s Health Initiative on 65,869
postmenopausal women found that women
with a history of periodontal (gum) disease
were 14 percent more likely to develop
cancer than those who did not have gum
disease. It’s not known why gum disease
might increase cancer risk. One hypothesis is
that bacteria that cause gum disease spread
through saliva or blood to other parts of the
body, where they create an environment
conducive to cancer cell growth.
LEARN MORE IN THE AUGUS T 2017 CANCER
EPIDEMIOLOGY, BIOMARKERS & PREVENTION.