Predictive Biomarkers for Neoadjuvant Chemotherapy in Breast Cancer

Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with early breast cancer links with better survival. In the meantime, post-neoadjuvant treatment strategies have proven useful even in the absence of pCR, causing a wide use of neoadjuvant systemic therapy in patients with early breast cancer and searching for predictive biomarkers of response. Neoadjuvant chemotherapy treatment strategies could be escalated or de-escalated based on better response prediction, ultimately improving early breast cancer clinical management. 

Clinico-pathological prognostic factors are currently employed to evaluate the potential benefit of neoadjuvant systemic treatment but are not adequately accurate to allow for personalized response prediction. Due to the intertumoral heterogeneity of breast cancer, certain factors have recently been proposed but cannot yet be implemented in daily clinical practice or are of limited utility.

A recent review by Derouane F. et al. describes the current knowledge about predictive factors for response to neoadjuvant chemotherapy in breast cancer patients. It also highlights the future perspectives that could cause better response prediction, concentrating on the current biomarkers used for clinical decision-making and the gene signatures recently proposed for patient stratification and the prediction of response to therapies. It also discusses the intratumoral phenotypic heterogeneity in breast cancers as well as the emerging techniques and relevant pre-clinical models that could integrate this biological factor currently limiting the reliable prediction of response to neoadjuvant systemic therapy.

It describes that promising techniques such as radiomics data, liquid biopsies, and their combination with more common clinical and histological characteristics may benefit in deriving effective new biomarkers of response to NAC and bypassing the inter- and intra-heterogeneity that characterize breast cancer.

Cancers (Basel). 2022 Aug 11;14(16):3876. doi: 10.3390/cancers14163876. PMID: 36010869; PMCID: PMC9405974.