Factors Affecting Pathological Complete Response in Locally Advanced Breast Cancer Cases Receiving Neoadjuvant Therapy: A Comprehensive Literature Review.

Abstract

Determining pathological complete response (pCR) could be an important step in planning individual treatment, hence improving the prognosis in terms of survival. Achieving breast pCR not only improves survival but is also linked to a disease-free axilla, therefore increasing the likelihood of avoiding axillary surgery safely. The current trend in de-escalating axillary management surgically or in applying radiotherapy to the axilla is dependent primarily on breast cancer (BC) patients achieving pCR. Studies have demonstrated that certain characteristics can predict pCR, even though it is still difficult to identify these elements. A review of the literature was carried out to determine these factors and their clinical applications. A search was carried out in the MEDLINE database using PubMed, Google Scholar, and EMBASE. This yielded 1368 studies, of which 60 satisfied the criteria. The studies were categorized according to the subject they dealt with. These parameters included age, race, subtypes, clinicopathological, immunological, imaging, obesity, Ki-67 status, vitamin D, and genetics. These factors, in combination, can be used for specific subtypes to individualize treatment and monitor response to therapy. The predictors of pCR are diverse and should be utilized to personalize patient treatment, ultimately inducing the best outcomes. These determinants can also be employed for monitoring responses to neoadjuvant therapy, thereby adjusting treatment. The development of standardized markers for the diversity of BC subtypes still needs additional future research. These factors must be applied in concert in order to provide optimal results.