Therefore, there is a need for predictive biomarkers to select patients who will not benefit from NAC in order to offer new therapeutic approaches to these patients. Since histologically similar tumors may demonstrate different prognoses and responses to therapy, some molecular subtypes of BC can have high rates of pCR to NAC, while others may not have the same benefits from being exposed to the same treatment. However, molecular markers can be effective in avoiding unnecessary treatments and associated toxicities for BC patients that do not respond to NAC. The identification of efficient molecular markers that can predict sensitivity to chemotherapy, demonstrate higher rates of pCR, and identify patients that can benefit from NAC in clinical practice has been a challenge in many recent studies. However, these markers require larger studies with long-term follow-up, and for this reason, they currently lack clinical validation. Studies have attempted to identify molecular biomarkers that could monitor patients with early pCR and avoid overtreatment in this population. Patients with documented RD are usually associated with a worse prognosis than those who achieve pCR, although RD can have a heterogeneous prognosis in each patient. RD is defined by the presence of breast cancer cells in the tumor bed and/or positive lymph nodes after surgical removal. Clinical staging, axillary lymph node status, and human epidermal growth factor receptor-2 (HER2) positivity are associated with cancer recurrence rates after NAC. Predicting which patients will achieve pCR or have residual disease (RD) may help suggest and plan a specific treatment according to patient’s characteristics, thus enabling personalized therapy. PCR is defined as the complete disappearance of all invasive breast carcinoma cells and axillary lymph nodes (ypT0/ypN0), and is determined pathologically in the resected tissue after NAC. pCR is an important long-term clinical outcome for patients with BC, as patients who achieve pCR with neoadjuvant therapy tend to have better disease-free survival (DFS) and overall survival (OS) compared with patients with residual invasive disease. Neoadjuvant chemotherapy (NAC) is an important treatment strategy for BC patients, with the aim of reducing staging and monitoring response to treatment for prognostic purposes, thereby increasing pathological complete response rate (pCR). Therefore, BCs are classified according to their characteristics, histological type, and expression of tumor markers, which develop from genetic and molecular changes in breast tissue cells. Furthermore, BC is heterogeneous and presents different morphological and biological characteristics, thus leading to different clinical behaviors and responses. The aim of this review is to compile the main biomarkers that predict pCR in BC after NAC.īreast cancer (BC) is the most commonly diagnosed malignancy and is responsible for the highest number of deaths among women worldwide. With the development of new “OMICS” technologies, i.e., genomics, transcriptomics, and proteomics, among others, the discovery of new biomarkers is increasingly being used in the context of clinical practice, bringing us closer to personalized management of BC treatment. The development of targeted therapies depends on identifying biomarkers that can be used to assess treatment efficacy as well as the discovery of new and more accurate therapeutic agents. Breast cancer (BC) is a heterogeneous disease that requires personalized treatment strategies. Those who do might have significant advantages in terms of survival rates. From the NAC response, it is possible to obtain prognostic information as patients may reach a pathological complete response (pCR). Neoadjuvant chemotherapy (NAC) is often used to treat locally advanced disease for tumor downstaging, thus improving the chances of breast-conserving surgery.
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