Neoadjuvant therapy

Neoadjuvant therapy
MeSHD020360

Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. One example is neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate. Neoadjuvant therapy aims to reduce the size or extent of the cancer before using radical treatment intervention, thus both making procedures easier and more likely to succeed and reducing the consequences of a more extensive treatment technique, which would be required if the tumor were not reduced in size or extent.

Another related concept is that neoadjuvant therapy acts on micrometastatic disease. The downstaging is then a surrogate marker of efficacy on undetected dissemination, resulting in improved longtime survival compared to the surgery-alone strategy.

This systemic therapy (chemotherapy, immunotherapy or hormone therapy) or radiation therapy is commonly used in cancers that are locally advanced, and clinicians plan an operation at a later stage, such as pancreatic cancer. The use of such therapy can effectively reduce the difficulty and morbidity of more extensive procedures.

Some neoadjuvant therapy can turn a tumor from untreatable to treatable by shrinking its volume. This is called conversion therapy; if chemotherapy is used, it is called conversion chemotherapy. Often, it is unclear which surrounding structures are directly involved in the disease and which are just showing signs of inflammation. By administering therapy, a distinction can often be made. Some doctors give the therapy in the hope that a response is seen, and they can then decide what is the best course of action. In some cases, magnetic resonance imaging can predict the response of a patient to neoadjuvant therapy, for example in ovarian cancer.

Clinical Implementation

Not everyone is suitable for neoadjuvant therapy because it can be extremely toxic. Some patients react so severely that further treatments, especially surgery, are precluded, and the patient is rendered unfit for anesthetic. Real-world evidence suggests that the uptake of neoadjuvant chemoimmunotherapy may remain limited despite its adoption as a standard of care for selected cancers. In stage II–IIIB non-small cell lung cancer, common barriers include comorbidities, poor functional status, and anatomical or technical factors, although patients who receive treatment generally have high rates of treatment completion and subsequent surgery.

See also

References

  1. ↑ Remiszewski, Piotr; Filipek, Kinga; Pisklak, Agata; Chmiel, Paulina; Rutkowski, Piotr; Czarnecka, Anna M. (2025-01-05). "Neoadjuvant or Adjuvant Chemotherapy in Soft-Tissue Sarcoma?". Current Oncology Reports. 27 (5): 491–515. doi:10.1007/s11912-024-01630-6. ISSN 1534-6269. PMID 40153167.
  2. ↑ Symonds, Lynn K; Cohen, Stacey A (2019-10-01). "Use of perioperative chemotherapy in colorectal cancer metastatic to the liver". Gastroenterology Report. 7 (5): 301–311. doi:10.1093/gastro/goz035. ISSN 2052-0034. PMC 6821343. PMID 31687149.
  3. ↑ Cui, Yuhan; Du, Zuchao; Xu, Jiahao; Gu, Lihui; Du, Jiaqi; Wang, Mingda; Yang, Tian (2026-03-30). "Surgery-centered integrated strategies for personalized hepatocellular carcinoma care". Cancer Biology & Medicine: 1–20. doi:10.20892/j.issn.2095-3941.2026.0045. PMID 41913379.
  4. ↑ Deen SS, Priest AN, McLean MA, Gill AB, Brodie C, Crawford R, et al. (July 2019). "Diffusion kurtosis MRI as a predictive biomarker of response to neoadjuvant chemotherapy in high grade serous ovarian cancer". Scientific Reports. 9 (1) 10742. Bibcode:2019NatSR...910742D. doi:10.1038/s41598-019-47195-4. PMC 6656714. PMID 31341212.
  5. ↑ Groenewold MD, Olthof CG, Bosch DJ (January 2022). "Anaesthesia after neoadjuvant chemotherapy, immunotherapy or radiotherapy". BJA Education. 22 (1): 12–19. doi:10.1016/j.bjae.2021.08.002. PMC 8703124. PMID 34992796.
  6. 1 2 Norman, Claire; Giles, Andrew; Robinson, Andrew; Mates, Mihaela; Genta, Sofia; Al Sibani, Maitha; Thanabalachandran, Luxiga; Jafari, Daniel; Hopman, Wilma; Li, Yuchen (2026-07-30). "Real-world uptake of neoadjuvant chemoimmunotherapy and surgery in patients with stage II-IIIB non-small cell lung cancer". Frontiers in Oncology. 16 1870140. doi:10.3389/fonc.2026.1870140. ISSN 2234-943X.

Further reading

  • [National Institutes of Health (NIH)]. "Adjuvant and Neoadjuvant Therapy for Breast Cancer". US National Institutes of Health (NIH). Archived from the original on 4 January 2015.
  • Rosenblatt R, Sherif A, Rintala E, Wahlqvist R, Ullén A, Nilsson S, Malmström PU, et al. (Nordic Urothelial Cancer Group) (June 2012). "Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer". European Urology. 61 (6): 1229–1238. doi:10.1016/j.eururo.2011.12.010. PMID 22189383.
  • Tollefson MK, Boorjian SA, Farmer SA, Frank I (December 2012). "Downstaging to non-invasive urothelial carcinoma is associated with improved outcome following radical cystectomy for patients with cT2 disease". World Journal of Urology. 30 (6): 795–799. doi:10.1007/s00345-012-0855-8. PMID 22447397. S2CID 231833.
  • Valentini V, Coco C, Picciocchi A, Morganti AG, Trodella L, Ciabattoni A, et al. (July 2002). "Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients". International Journal of Radiation Oncology, Biology, Physics. 53 (3): 664–674. doi:10.1016/S0360-3016(02)02764-5. PMID 12062610.