MaltSci 麦伴科研

Appearance

Popular Reports / Cancer Research

This report is written by MaltSci based on the latest literature and research findings

How does neoadjuvant therapy improve cancer treatment outcomes? ​

Abstract ​

Neoadjuvant therapy has emerged as a pivotal strategy in cancer treatment, significantly improving surgical outcomes and overall survival rates. This approach involves administering therapeutic agents before surgical intervention to reduce tumor size, eliminate micrometastatic disease, and allow for real-time assessment of tumor response. The multifaceted benefits of neoadjuvant therapy include converting inoperable tumors into operable ones, enhancing the understanding of tumor biology, and tailoring treatment regimens in the era of personalized medicine. Current research underscores that neoadjuvant therapy is not only as effective as traditional adjuvant therapy but offers distinct advantages, such as improved surgical resectability and earlier assessment of treatment response. Achieving pathological complete remission in neoadjuvant settings is associated with favorable long-term clinical outcomes, particularly in aggressive cancer subtypes like HER2-positive and triple-negative breast cancers. However, challenges such as treatment-related toxicity and variability in patient responses must be addressed to maximize the benefits of this therapeutic approach. Future directions focus on identifying biomarkers for patient selection and developing personalized neoadjuvant strategies that integrate novel therapeutic agents, including immunotherapies and targeted therapies. Through this comprehensive analysis, the role of neoadjuvant therapy in enhancing cancer treatment outcomes is elucidated, contributing to the optimization of patient care in oncology.

Outline ​

This report will discuss the following questions.

  • 1 Introduction
  • 2 Mechanisms of Action
    • 2.1 Tumor Size Reduction
    • 2.2 Elimination of Micrometastases
    • 2.3 Assessment of Tumor Response
  • 3 Types of Neoadjuvant Therapy
    • 3.1 Chemotherapy
    • 3.2 Radiotherapy
    • 3.3 Targeted Therapy and Immunotherapy
  • 4 Clinical Outcomes
    • 4.1 Surgical Outcomes
    • 4.2 Long-term Survival Rates
    • 4.3 Quality of Life Considerations
  • 5 Challenges and Limitations
    • 5.1 Treatment-related Toxicity
    • 5.2 Variability in Patient Response
    • 5.3 Optimal Timing and Regimen Selection
  • 6 Future Directions
    • 6.1 Novel Therapeutic Agents
    • 6.2 Biomarkers for Patient Selection
    • 6.3 Personalized Neoadjuvant Strategies
  • 7 Summary

1 Introduction ​

Neoadjuvant therapy has emerged as a pivotal strategy in the management of various cancers, particularly in the context of improving surgical outcomes and enhancing overall survival rates. This therapeutic approach involves administering treatment prior to surgical intervention, aiming to reduce tumor size, eliminate micrometastatic disease, and provide real-time assessment of tumor response to therapy. The increasing adoption of neoadjuvant therapy reflects a growing recognition of its multifaceted benefits, including the potential to convert inoperable tumors into operable ones, thereby expanding treatment options for patients who might otherwise face limited prospects[1][2].

The significance of neoadjuvant therapy extends beyond immediate clinical outcomes; it serves as a crucial platform for understanding tumor biology and treatment efficacy. By evaluating tumor responses in vivo, clinicians can gain insights into the biological behavior of tumors, allowing for more tailored therapeutic strategies. This aspect is particularly valuable in the era of personalized medicine, where treatment regimens can be adjusted based on individual tumor characteristics and patient responses[3][4]. Moreover, the integration of novel therapeutic agents, including immunotherapies and targeted therapies, within the neoadjuvant setting is rapidly evolving, further enhancing the therapeutic landscape for cancer patients[2][5].

Current research indicates that neoadjuvant therapy is not only equivalent to traditional adjuvant therapy in efficacy but also offers distinct advantages, such as improved surgical resectability and the ability to assess treatment response earlier in the disease course[1][6]. Furthermore, achieving pathological complete remission in neoadjuvant settings has been associated with favorable long-term clinical outcomes, particularly in aggressive cancer subtypes like HER2-positive and triple-negative breast cancers[3][7]. The shift towards neoadjuvant strategies is supported by an increasing body of evidence suggesting that this approach can lead to better management of cancer and ultimately, improved patient survival rates[2][4].

Despite its advantages, the application of neoadjuvant therapy is not without challenges. Issues such as treatment-related toxicity, variability in patient responses, and the complexities of optimal regimen selection must be addressed to maximize the benefits of this therapeutic approach[2][5]. As the field continues to evolve, it is imperative to explore future directions, including the identification of biomarkers for patient selection and the development of personalized neoadjuvant strategies[4][5].

This review will be organized as follows: first, we will delve into the mechanisms by which neoadjuvant therapy enhances treatment outcomes, focusing on tumor size reduction, elimination of micrometastases, and assessment of tumor response. Next, we will categorize the various types of neoadjuvant therapies currently in use, including chemotherapy, radiotherapy, and emerging modalities such as targeted therapy and immunotherapy. Following this, we will examine clinical outcomes associated with neoadjuvant therapy, encompassing surgical outcomes, long-term survival rates, and quality of life considerations. The challenges and limitations inherent to neoadjuvant approaches will also be discussed, particularly concerning treatment-related toxicity and variability in patient responses. Finally, we will highlight future directions in this field, emphasizing the potential of novel therapeutic agents, the role of biomarkers in patient selection, and the promise of personalized neoadjuvant strategies. Through this comprehensive analysis, we aim to elucidate the role of neoadjuvant therapy in enhancing cancer treatment outcomes, ultimately contributing to the optimization of patient care in oncology.

2 Mechanisms of Action ​

2.1 Tumor Size Reduction ​

Neoadjuvant therapy has emerged as a critical component in the treatment of various cancers, primarily due to its ability to reduce tumor size and improve surgical outcomes. The mechanisms through which neoadjuvant therapy achieves these improvements are multifaceted, encompassing both direct tumor responses and indirect effects on the tumor microenvironment.

One of the primary benefits of neoadjuvant therapy is its capacity to decrease tumor size, thereby facilitating surgical resection. For instance, in locally advanced rectal cancer, neoadjuvant chemoradiotherapy not only reduces tumor size but also enhances the tumor resection rate and the anus retention rate, with minimal side effects [8]. This reduction in tumor size can lead to a more favorable surgical outcome, allowing for less extensive surgeries and preserving surrounding healthy tissues.

In the context of genitourinary cancers, neoadjuvant therapies are designed to improve tolerability and reduce tumor volume, which in turn facilitates surgical intervention. These therapies are particularly effective when administered to treatment-naive patients, as they can elicit a robust drug response that may not be seen in patients who have undergone previous treatments [4]. The enthusiasm surrounding neoadjuvant approaches stems from their potential to not only shrink tumors but also to reduce the likelihood of recurrence and enhance survival rates in patients with localized or locally advanced cancers.

Moreover, the application of neoadjuvant therapy allows for an in vivo assessment of the tumor's response to treatment, providing critical information that can guide subsequent therapeutic strategies. For example, in breast cancer, the reduction in tumor size serves as an indicator of the sensitivity of tumor cells to the administered agents [9]. This aspect of neoadjuvant therapy enables clinicians to tailor subsequent treatments based on the observed responses, potentially leading to improved patient outcomes.

Additionally, neoadjuvant therapy has been shown to alter the immune microenvironment within tumors, particularly in pancreatic cancer, where it can enhance the effectiveness of subsequent immunotherapies. The therapy can help in eliminating tumor cell micrometastases and improving the R0 resection rate, which is crucial for long-term survival [10]. By modifying the immune landscape, neoadjuvant therapy may also render tumors more susceptible to immune-mediated destruction.

In summary, neoadjuvant therapy improves cancer treatment outcomes primarily through mechanisms of tumor size reduction, enhancement of surgical resectability, and modulation of the tumor microenvironment. These factors collectively contribute to better surgical outcomes, lower recurrence rates, and improved survival in various cancer types. The ongoing research and clinical trials continue to refine these approaches, aiming to maximize the benefits of neoadjuvant therapy across different malignancies.

2.2 Elimination of Micrometastases ​

Neoadjuvant therapy plays a significant role in improving cancer treatment outcomes through various mechanisms, particularly by targeting micrometastases. The administration of neoadjuvant therapy prior to surgical intervention serves to eradicate not only the primary tumor but also any micrometastatic disease that may be present. This approach is critical, as micrometastases often contribute to cancer recurrence and metastasis, representing a significant challenge in achieving long-term remission.

In the context of pancreatic cancer, neoadjuvant therapy has been recognized for its ability to enhance the R0 resection rate, which is the complete removal of the tumor with negative margins. This therapy helps in eliminating tumor cell micrometastases that could lead to recurrence post-surgery. The dense mechanical barrier and profound infiltration of immunosuppressive cells in the pancreatic tumor microenvironment create a challenging scenario for effective treatment; however, neoadjuvant therapy alters this microenvironment, facilitating better immune responses against residual disease [10].

For breast cancer, neoadjuvant chemotherapy (NACT) has demonstrated effectiveness in reducing tumor size, thus enabling total tumor resection. Importantly, NACT is believed to be more effective in targeting micrometastases compared to chemotherapy administered post-surgery. The changes induced by NACT in the tumor microenvironment, such as alterations in angiogenesis and immune-inflammatory reactions, can inadvertently promote distant metastasis. Nevertheless, the ability of NACT to address micrometastatic disease remains a crucial aspect of its therapeutic benefit [11].

In advanced-stage melanoma, neoadjuvant therapy, particularly immunotherapy, is gaining traction as it may elicit a more robust immune response than adjuvant therapies. The primary tumor serves as an antigenic source during this phase, which can enhance systemic anti-tumor immunity. The ability to decrease tumor size not only facilitates surgical resection but also allows for the assessment of pathologic response, which can inform subsequent treatment strategies [12].

Additionally, in non-small cell lung cancer (NSCLC), the objective of neoadjuvant therapy is to eradicate both the primary tumor and any micrometastatic disease. Clinical trials have shown that neoadjuvant chemotherapy can achieve a clinical response rate exceeding 50%, with about 20% of patients experiencing sterilization of the tumor following resection. This outcome correlates with significantly improved survival rates [13].

Overall, neoadjuvant therapy provides a multifaceted approach to cancer treatment, enhancing surgical outcomes by addressing micrometastatic disease, thereby reducing the likelihood of recurrence and improving overall survival rates across various cancer types. The strategic timing of therapy, combined with surgical intervention, creates a synergistic effect that can optimize patient outcomes and offers a promising avenue for future research and therapeutic development.

2.3 Assessment of Tumor Response ​

Neoadjuvant therapy has emerged as a pivotal strategy in cancer treatment, particularly for breast cancer, pancreatic cancer, and lung cancer, by enhancing treatment outcomes through various mechanisms of action and methods for assessing tumor response.

One of the primary mechanisms through which neoadjuvant therapy improves outcomes is its ability to downstage tumors, making previously inoperable tumors resectable. In breast cancer, neoadjuvant chemotherapy not only provides clinical outcomes equivalent to those achieved in the adjuvant setting but also allows for a reduction in tumor burden, which alleviates the morbidity associated with locoregional therapy. This therapeutic approach can lead to significant prognostic insights based on the response to treatment and the characteristics of any residual disease, thus informing future adjuvant therapies (Haddad and Goetz 2015) [14].

In the context of pancreatic cancer, neoadjuvant therapy has been shown to remodel the tumor microenvironment. Specifically, it can reverse the immunosuppressive characteristics of malignant cells, leading to a selective depletion of regulatory T cells and myeloid-derived suppressor cells. This remodeling is associated with an enrichment of antitumor immune cells in the peritumoral niche, which correlates with better histopathologic responses and improved patient survival outcomes (Mota Reyes et al. 2020) [15]. The alteration of the immune microenvironment is crucial, as it not only enhances the cytotoxic effects of the therapy but also supports the development of more effective combinatorial strategies, including immunotherapy (Zhang et al. 2022) [10].

Assessment of tumor response to neoadjuvant therapy is essential for determining the efficacy of treatment and guiding subsequent management strategies. Traditional evaluation methods often rely on changes in tumor size, which can be limited in their predictive value. Therefore, advanced imaging techniques that assess vascular, metabolic, and molecular changes in tumors are increasingly utilized. These methods can detect specific biological markers and predict early responses to therapy, thus guiding individualized treatment plans (Rauch et al. 2017) [16]. Furthermore, achieving a pathologic complete response is recognized as a valuable surrogate prognostic factor for survival, emphasizing the importance of accurately evaluating therapeutic efficacy (Wang and Mao 2020) [17].

In conclusion, neoadjuvant therapy enhances cancer treatment outcomes through mechanisms that include tumor downstaging, immune microenvironment remodeling, and providing critical prognostic information based on tumor response. The evolving landscape of neoadjuvant treatment underscores the necessity for robust assessment techniques to fully capitalize on the therapeutic benefits offered by this approach across various cancer types.

3 Types of Neoadjuvant Therapy ​

3.1 Chemotherapy ​

Neoadjuvant therapy, particularly neoadjuvant chemotherapy, has become a significant component in the management of various cancers, notably early-stage breast cancer and locally advanced rectal cancer. The primary objectives of neoadjuvant chemotherapy include tumor downstaging, improving surgical resectability, and providing early insights into the tumor's response to treatment, which can inform subsequent therapeutic strategies.

In the context of breast cancer, neoadjuvant chemotherapy allows a greater proportion of patients to undergo breast conservation surgery, as it can effectively reduce tumor size before surgical intervention. This preoperative approach also facilitates the early assessment of response or resistance to chemotherapy, enabling clinicians to tailor subsequent treatment plans based on the patient's specific tumor biology and response to initial therapy (Moreno-Aspitia 2012) [6].

The potential benefits of neoadjuvant chemotherapy extend beyond mere size reduction. Studies have indicated that this treatment modality may yield clinical outcomes equivalent to those achieved with adjuvant chemotherapy. The reduction in tumor burden can alleviate the morbidity associated with locoregional therapies, and the evaluation of treatment response serves as a prognostic biomarker, providing critical information regarding the quantity and biology of residual disease (Haddad and Goetz 2015) [14].

Furthermore, neoadjuvant therapy allows for the integration of novel agents and treatment paradigms, particularly in the context of targeted therapies. For instance, advancements in anti-HER2 therapies have led to substantial improvements in the pathological complete response rates in HER2-positive breast cancer patients, suggesting that neoadjuvant approaches may provide additional survival benefits compared to traditional adjuvant settings (De Mattos-Arruda et al. 2016) [3].

In rectal cancer, the combination of neoadjuvant chemoradiation therapy with improved surgical techniques has significantly enhanced local control and overall survival rates for patients with locally advanced disease. However, the role of adjuvant chemotherapy in patients who achieve a pathological complete response is currently under scrutiny, as some studies suggest minimal to no benefit from this additional treatment in select groups (Nelson and Benson 2013) [18].

In summary, neoadjuvant chemotherapy improves cancer treatment outcomes by facilitating tumor downstaging, enhancing surgical options, providing early prognostic information, and enabling the evaluation of novel therapies in a preoperative setting. The ongoing research into biomarkers and treatment response will likely continue to refine the use of neoadjuvant therapy, tailoring approaches to individual patient needs and tumor characteristics.

3.2 Radiotherapy ​

Neoadjuvant therapy has emerged as a critical component in the management of various cancers, particularly for locally advanced tumors. This approach involves administering treatment before surgical intervention, with the aim of improving surgical outcomes and overall survival rates. Among the types of neoadjuvant therapy, radiotherapy plays a significant role, particularly in enhancing local control of the disease and potentially improving the chances of achieving complete resection.

Radiotherapy, when used in a neoadjuvant setting, is primarily aimed at reducing tumor size and eliminating micrometastases, thereby increasing the likelihood of achieving an R0 resection (complete removal of the tumor with negative margins). For instance, in patients with locally advanced rectal cancer (LARC), neoadjuvant concurrent radiotherapy (nCRT) has been shown to significantly improve the likelihood of R0 resection. The combination of radiotherapy and chemotherapy not only aids in tumor downstaging but also helps in managing the residual cancer cells post-surgery, ultimately contributing to better long-term outcomes [19].

Furthermore, studies such as the CROSS and NEOCRTEC5010 trials have demonstrated that neoadjuvant concurrent chemoradiotherapy significantly enhances survival compared to surgery alone [20]. These findings underscore the importance of radiotherapy in neoadjuvant treatment protocols, particularly for esophageal cancer, where it has been associated with improved histological complete response rates and lower frequencies of lymph-node metastases [21].

Neoadjuvant radiotherapy also facilitates organ preservation strategies, particularly in cancers such as laryngeal squamous cell carcinoma, where it allows for laryngeal preservation in a majority of patients without compromising overall survival [22]. This aspect is increasingly important as the incidence of certain cancers becomes more prevalent in younger populations, who may prioritize quality of life alongside treatment efficacy.

Despite these advantages, the integration of radiotherapy into neoadjuvant regimens is not without debate. Some studies suggest that while radiotherapy can enhance local control and improve surgical outcomes, its impact on overall survival may be less pronounced when compared to modern chemotherapy regimens [23]. Ongoing trials are exploring the optimal combinations of neoadjuvant therapies, including the potential role of immunotherapy in conjunction with chemoradiotherapy, which may further enhance the effectiveness of treatment [2].

In summary, neoadjuvant radiotherapy improves cancer treatment outcomes by enhancing the likelihood of complete surgical resection, reducing tumor burden, and potentially improving long-term survival rates. However, the exact role of radiotherapy in neoadjuvant settings continues to evolve, necessitating further research to refine treatment strategies and address existing knowledge gaps.

3.3 Targeted Therapy and Immunotherapy ​

Neoadjuvant therapy, which is administered prior to surgery, has emerged as a pivotal approach in enhancing cancer treatment outcomes across various malignancies. This therapeutic strategy encompasses both targeted therapy and immunotherapy, each playing a significant role in improving patient prognosis.

Neoadjuvant targeted therapy aims to reduce tumor burden before surgical intervention, thereby facilitating more successful surgical outcomes. In the context of melanoma, for instance, targeted therapy has been shown to yield effective neoadjuvant cytoreduction. This approach not only decreases the tumor size but also enhances the overall response to subsequent treatments, as the primary tumor can act as a target for the immune system. Additionally, it has been observed that neoadjuvant therapy may lead to a more robust immune response compared to adjuvant therapy, where treatment occurs after surgery, as the immune system is exposed to a larger tumor antigen load during the neoadjuvant phase (Bushara et al. 2023) [12].

Immunotherapy, particularly neoadjuvant immunotherapy, is gaining traction due to its potential to augment anti-tumor immune responses. The rationale behind this approach lies in the ability of neoadjuvant immunotherapy to utilize the primary tumor as a source of antigens, thus generating a stronger immune response. For example, in head and neck squamous cell carcinoma (HNSCC), the administration of immunotherapy prior to surgery has shown promise in enhancing clinical outcomes by improving the immune microenvironment, which is often not influenced by prior therapies (Shibata et al. 2021) [24]. Furthermore, neoadjuvant immunotherapy has been associated with improved pathologic responses, allowing for better prognostication and personalized treatment planning (Sávio do Rego Lins Junior et al. 2024) [25].

The advantages of neoadjuvant therapy extend beyond immediate tumor reduction and immune activation. For instance, this therapeutic approach has been linked to a decrease in surgical morbidity, as smaller tumors may require less extensive surgical procedures. Additionally, it provides an opportunity to evaluate the pathological response to treatment, which can inform subsequent therapeutic strategies (Chen & Ma 2021) [26]. Notably, some patients may achieve a complete pathological response, allowing them to potentially avoid surgery altogether, thereby altering the traditional surgery-first paradigm in cancer treatment (Bushara et al. 2023) [12].

Moreover, the application of neoadjuvant therapies is not limited to specific cancer types. Research has indicated that neoadjuvant immunotherapy can be beneficial across various cancers, including non-small cell lung cancer (NSCLC), where it has demonstrated the ability to lower tumor load and improve surgical resection rates (Chen & Liu 2025) [27]. The flexibility of neoadjuvant approaches allows for the incorporation of different treatment modalities, including combinations of immunotherapy with chemotherapy or targeted agents, enhancing the therapeutic landscape and offering tailored solutions for patients.

In summary, neoadjuvant therapy, particularly through the integration of targeted therapy and immunotherapy, significantly improves cancer treatment outcomes by reducing tumor burden, enhancing immune responses, and providing critical insights into treatment efficacy and patient prognosis. Ongoing research is essential to optimize treatment protocols, establish reliable biomarkers for response, and refine patient selection criteria to maximize the benefits of neoadjuvant therapies across diverse malignancies.

4 Clinical Outcomes ​

4.1 Surgical Outcomes ​

Neoadjuvant therapy, which is administered prior to surgical intervention, has been shown to improve cancer treatment outcomes through several mechanisms that enhance both clinical and surgical results. This approach is increasingly recognized for its role in managing various cancer types, particularly breast and genitourinary cancers.

One of the primary benefits of neoadjuvant therapy is its ability to downstage tumors, thereby making initially inoperable tumors resectable. For instance, in breast cancer, neoadjuvant therapy can lead to pathological complete remission, which is associated with long-term clinical benefits, particularly in subtypes such as HER2-positive and triple-negative breast cancer. Achieving such remission correlates with improved survival rates, as evidenced by studies indicating that neoadjuvant therapy can effectively facilitate breast conservation strategies instead of radical mastectomy, ultimately improving patients' quality of life (Colomer et al., 2019; Thompson & Moulder-Thompson, 2012).

Furthermore, neoadjuvant therapy provides a unique opportunity to assess tumor response to treatment in real-time. This assessment can inform future adjuvant treatment strategies and improve prognostic predictions. By evaluating the biological response of tumors to therapy before surgery, clinicians can tailor subsequent treatments more effectively. For example, neoadjuvant chemotherapy has been shown to correlate with favorable prognosis in various cancers by allowing for direct evaluation of treatment efficacy through pathological examination of surgical specimens (Trimble et al., 1993; Hyder et al., 2021).

Additionally, neoadjuvant therapies have been associated with reduced tumor volume, which can facilitate surgical resection and minimize the extent of surgery required. This is particularly relevant in genitourinary cancers, where neoadjuvant therapies have historically been utilized for bladder cancer and are now being explored for renal and prostate cancers. The potential for improved tolerability and reduced recurrence rates further underscores the clinical relevance of this approach (Nair et al., 2023).

Moreover, the integration of neoadjuvant immunotherapy has shown promise in enhancing surgical outcomes. Recent studies indicate that neoadjuvant immune checkpoint blockade can expand and modify tumor-specific T cell responses, thereby improving both intratumoral and systemic anti-tumor immunity. This "window of opportunity" not only enhances surgical resectability but also allows for the identification of novel biomarkers associated with treatment response and resistance (Topalian et al., 2023; Awada et al., 2025).

In conclusion, neoadjuvant therapy improves cancer treatment outcomes by facilitating tumor downstaging, allowing for real-time assessment of treatment efficacy, and enhancing surgical resectability. The combination of these factors leads to better prognostic outcomes and may ultimately contribute to improved survival rates for patients undergoing surgical intervention for various malignancies. The ongoing research into the optimization of neoadjuvant treatment strategies continues to expand the potential benefits of this approach across different cancer types.

4.2 Long-term Survival Rates ​

Neoadjuvant therapy has emerged as a pivotal strategy in cancer treatment, particularly for various solid tumors, by enhancing clinical outcomes and long-term survival rates. This approach involves administering therapeutic agents, such as chemotherapy or radiotherapy, before the primary surgical intervention, thereby facilitating tumor downstaging and potentially improving surgical outcomes.

In the context of esophageal cancer, a randomized clinical trial comparing neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) revealed significant benefits associated with the addition of radiotherapy. The study demonstrated that histological complete response was achieved in 28% of patients receiving nCRT compared to only 9% in the nCT group (P = 0.002). Furthermore, the R0 resection rate was notably higher in the nCRT group at 87% versus 74% in the nCT group (P = 0.04), and lymph-node metastases were less frequent in the nCRT group (35% vs. 62% in the nCT group, P = 0.001). Although there was no difference in overall survival between the two treatment arms, the findings underscore the potential of neoadjuvant therapy to improve surgical outcomes and reduce metastasis, which can contribute to long-term survival benefits [21].

In pancreatic cancer, a retrospective analysis of patients with resectable pancreatic adenocarcinoma indicated that neoadjuvant therapy was associated with improved overall survival compared to adjuvant therapy. The median survival for patients receiving neoadjuvant therapy was significantly better at 34 months compared to 19 months for those receiving adjuvant therapy (P = 0.003). Additionally, the neoadjuvant group exhibited a lower rate of lymph node positivity (45% vs. 65%, P = 0.011), highlighting the efficacy of neoadjuvant therapy in reducing metastatic spread and enhancing long-term survival prospects [28].

Conversely, a study focusing on gastric adenocarcinoma survivors indicated that while neoadjuvant chemotherapy was initially associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46-0.96), this association diminished after adjusting for confounding factors, suggesting that neoadjuvant chemotherapy did not significantly impact long-term survival outcomes in a population-based cohort [29]. This highlights the complexity of neoadjuvant therapy's role in improving survival, as patient selection and tumor characteristics may influence outcomes.

Furthermore, neoadjuvant therapy has shown promise in breast cancer, where it allows for in vivo assessment of treatment efficacy and potentially reduces the need for extensive surgical interventions. Trials have demonstrated substantial improvements in pathological complete response rates with neoadjuvant dual-agent HER2 blockade, which is a proposed surrogate endpoint for long-term clinical benefit [3].

In summary, neoadjuvant therapy can improve cancer treatment outcomes by enhancing the rates of complete pathological response, reducing metastasis, and improving overall survival in certain cancer types. However, the impact on long-term survival may vary based on tumor type, treatment modalities, and patient characteristics, necessitating further research to optimize treatment protocols and maximize benefits across diverse cancer populations.

4.3 Quality of Life Considerations ​

Neoadjuvant therapy has emerged as a pivotal approach in cancer treatment, particularly in the context of improving clinical outcomes and quality of life for patients. This therapeutic strategy involves administering treatment, such as chemotherapy or immunotherapy, prior to surgical intervention, allowing for several advantages that directly impact patient outcomes.

One significant benefit of neoadjuvant therapy is its ability to downstage tumors, thereby rendering initially inoperable cancers resectable. This is particularly relevant in breast cancer, where neoadjuvant treatment has been shown to facilitate breast conservation surgery, thus minimizing the extent of surgical intervention required. Studies have indicated that neoadjuvant therapy can increase the likelihood of achieving a pathological complete response, which is associated with improved long-term survival, especially in subtypes such as HER2-positive and triple-negative breast cancer [1].

Moreover, neoadjuvant therapy provides an opportunity for early assessment of tumor response, which is critical for tailoring subsequent treatment plans. The response to neoadjuvant treatment serves as a prognostic indicator, allowing clinicians to predict recurrence risks and adjust adjuvant therapies accordingly [7]. This individualized approach not only optimizes therapeutic efficacy but also enhances the overall quality of life by potentially reducing the burden of extensive surgical procedures and the associated recovery time.

In terms of quality of life considerations, neoadjuvant therapy has been associated with improved tolerability of subsequent treatments. For instance, patients undergoing neoadjuvant chemotherapy for breast cancer have reported enhanced quality of life due to the opportunity for breast-conserving surgery, which is often preferred over mastectomy [30]. Additionally, by addressing the tumor before surgery, patients may experience less psychological distress associated with the uncertainty of their treatment outcomes.

The integration of neoadjuvant immunotherapy is also notable, as it has been found to enhance systemic anti-tumor immunity and provide insights into the biological behavior of tumors. This approach opens a "window of opportunity" to identify novel biomarkers of response and resistance, further refining treatment strategies and potentially improving long-term outcomes [2].

Furthermore, neoadjuvant therapy has demonstrated cost-effectiveness by reducing the need for radical surgeries and minimizing hospital stays, which contributes positively to the patient's overall experience and quality of life [1].

In conclusion, neoadjuvant therapy not only improves clinical outcomes through tumor downstaging and enhanced surgical options but also plays a crucial role in preserving and improving the quality of life for cancer patients. By allowing for personalized treatment strategies and reducing the extent of surgical interventions, neoadjuvant therapy represents a significant advancement in the management of various cancer types.

5 Challenges and Limitations ​

5.1 Treatment-related Toxicity ​

Neoadjuvant therapy, defined as systemic treatment administered prior to local treatment such as surgery, has become increasingly prominent in cancer management due to its potential to improve treatment outcomes. It offers several advantages, including tumor downstaging, early assessment of treatment response, and the opportunity for organ-sparing surgeries. However, the application of neoadjuvant therapy is not without challenges, particularly concerning treatment-related toxicity.

The efficacy of neoadjuvant therapy is evident in various cancer types. For instance, in a prospective cohort study involving 286 patients with potentially curable oesophageal adenocarcinoma, it was observed that neoadjuvant therapy-related toxicity was common, with 67 patients experiencing adverse events. Notably, 46 patients suffered severe, life-threatening, or fatal adverse events. The study found that 47% of patients with toxicity did not complete the chemotherapy course, compared to only 17% of those without toxicity, indicating a significant impact on treatment adherence (RR 2.7, 95% CI 1.7-4.4, P < 0.001). Furthermore, the overall survival was significantly shorter in patients suffering from toxicity, with a median survival of 20.7 months compared to 37.8 months in those without toxicity (P = 0.008) [31].

In breast cancer treatment, neoadjuvant chemotherapy has been associated with improved clinical outcomes. It allows for a greater proportion of patients to undergo breast conservation surgery, as well as facilitating the early evaluation of treatment response [6]. However, the treatment can lead to severe toxicity. A study assessing primary chemotherapy in high-risk breast cancer patients found that grade III-IV toxicity occurred in 81% of cycles, predominantly neutropenia, with other significant adverse effects such as anemia and thrombocytopenia also noted [32].

The timing between neoadjuvant therapy and subsequent surgery is crucial. While neoadjuvant therapy provides several advantages, it also necessitates a recovery period to mitigate toxicity, particularly hematological toxicity, before surgery can be performed [33]. Delays in surgery may impact the overall treatment effectiveness and patient outcomes.

In summary, while neoadjuvant therapy can enhance cancer treatment outcomes through various mechanisms such as tumor downstaging and enabling organ-sparing surgeries, it also poses significant challenges related to treatment-related toxicity. The incidence of severe adverse events can lead to incomplete treatment courses and negatively affect survival rates. Therefore, ongoing efforts must focus on minimizing toxicity and identifying predictive factors to improve patient selection and treatment strategies in the neoadjuvant setting [6][31][32].

5.2 Variability in Patient Response ​

Neoadjuvant therapy has emerged as a pivotal strategy in the treatment of various cancers, particularly in enhancing treatment outcomes. The approach involves administering systemic therapy prior to surgical intervention, aiming to reduce tumor burden and improve surgical options. Several mechanisms contribute to the effectiveness of neoadjuvant therapy in improving cancer treatment outcomes.

One of the primary advantages of neoadjuvant therapy is its ability to facilitate tumor downstaging, making previously inoperable tumors resectable. This is particularly relevant in cases of locally advanced breast cancer, where neoadjuvant chemotherapy has been shown to yield clinical outcomes equivalent to those achieved with adjuvant therapy [14]. The treatment allows for in vivo assessment of therapeutic efficacy, which can guide future adjuvant treatment decisions based on the tumor's response [3].

Furthermore, neoadjuvant therapy provides an opportunity to evaluate the biological characteristics of tumors and their response to treatment. For instance, the pathological complete response (pCR) observed in patients undergoing neoadjuvant treatment is associated with improved long-term survival [34]. Trials have demonstrated that certain patient populations, such as those with triple-negative breast cancer (TNBC), benefit from the addition of immunotherapy during neoadjuvant treatment, enhancing prognosis compared to chemotherapy alone [35].

Despite these advantages, the variability in patient response to neoadjuvant therapy poses significant challenges. Individual differences in tumor biology, genetic mutations, and overall health can lead to disparate outcomes. For example, the effectiveness of dual anti-HER2 therapy in HER2-positive breast cancer has shown promising pCR rates, but this does not consistently translate into improved survival for all patients [34]. Similarly, emerging biomarkers such as tumor-infiltrating lymphocytes and PIK3CA mutations are being investigated for their potential to predict treatment response, yet the clinical application of these markers remains in development [34].

Additionally, there are inherent limitations to neoadjuvant therapy. While it may improve local control and reduce the extent of surgery required, there is a risk of increased toxicity and potential delays in effective treatment if the initial response is inadequate [22]. Furthermore, the necessity for rigorous clinical trial designs to evaluate the efficacy of neoadjuvant strategies against standard treatments underscores the complexity of integrating these therapies into routine practice [36].

In conclusion, while neoadjuvant therapy offers significant potential for improving cancer treatment outcomes through tumor downstaging and enhanced prognostic assessment, the variability in patient responses and the need for personalized treatment strategies remain critical challenges. Ongoing research and clinical trials are essential to optimize neoadjuvant treatment protocols and to identify reliable biomarkers that can help tailor therapy to individual patient needs [25][35].

5.3 Optimal Timing and Regimen Selection ​

Neoadjuvant therapy, which involves administering treatment prior to surgical intervention, has become an integral component in the management of various cancers, particularly breast cancer. This approach has demonstrated several advantages that contribute to improved treatment outcomes, though it also presents certain challenges and limitations.

Neoadjuvant therapy is primarily aimed at reducing tumor size, thereby enhancing surgical resectability and potentially allowing for breast-conserving surgery instead of mastectomy. The early administration of treatment enables clinicians to assess the tumor's response to therapy in vivo, which provides valuable prognostic information. For instance, achieving a pathological complete response (pCR) following neoadjuvant therapy has been correlated with favorable long-term clinical outcomes, especially in aggressive subtypes such as HER2-positive and triple-negative breast cancer (Colomer et al. 2019) [1].

Moreover, neoadjuvant therapy can serve as a powerful platform for evaluating new treatment modalities and identifying predictive biomarkers. This is particularly important in the context of personalized medicine, where understanding the molecular characteristics of a tumor can guide treatment decisions and improve efficacy (Topalian et al. 2023) [2]. For example, neoadjuvant immune checkpoint blockade has been recognized for its ability to enhance systemic anti-tumor immunity and improve clinical outcomes by expanding tumor-specific T cell clones (Topalian et al. 2023) [2].

However, despite these benefits, the implementation of neoadjuvant therapy is not without challenges. One significant limitation is the potential for treatment-related toxicity, which can impact patients' overall health and complicate subsequent surgical procedures. Furthermore, the timing and selection of therapeutic regimens must be carefully considered. Optimal timing is crucial, as delays in surgery following neoadjuvant therapy can lead to disease progression (De Mattos-Arruda et al. 2016) [3]. Additionally, while neoadjuvant chemotherapy has shown equivalent efficacy to adjuvant chemotherapy, it has not universally demonstrated a survival advantage, indicating that patient selection and regimen optimization are vital (Moreno-Aspitia 2012) [6].

The challenge of regimen selection is further compounded by the heterogeneity of tumor biology. Individual patient responses to neoadjuvant therapy can vary significantly based on factors such as tumor subtype, genetic mutations, and overall health status. Therefore, ongoing research is necessary to refine treatment protocols and establish the most effective combinations of therapies for different cancer types (Thompson & Moulder-Thompson 2012) [30].

In conclusion, while neoadjuvant therapy offers significant potential for improving cancer treatment outcomes through tumor downstaging, in vivo response assessment, and the facilitation of surgical interventions, careful consideration of timing, regimen selection, and patient-specific factors is essential to maximize its benefits and mitigate associated risks. The ongoing evolution of this treatment paradigm will likely continue to enhance the management of cancer in the future.

6 Future Directions ​

6.1 Novel Therapeutic Agents ​

Neoadjuvant therapy has emerged as a pivotal approach in cancer treatment, particularly for early-stage and locally advanced cancers. It is defined as the administration of therapeutic agents before the primary treatment, such as surgery, with the intent of improving patient outcomes. This strategy has been shown to enhance treatment efficacy and facilitate a deeper understanding of tumor biology.

One of the primary advantages of neoadjuvant therapy is its ability to achieve equivalent efficacy compared to adjuvant therapy while providing unique benefits. For instance, it can lead to increased rates of breast conservation, as demonstrated in breast cancer cases where neoadjuvant therapy correlates with a higher likelihood of achieving pathological complete remission (pCR). This is particularly evident in HER2-positive and triple-negative breast cancer subtypes, where pCR has been associated with improved long-term clinical outcomes [1].

Neoadjuvant therapy allows for in vivo assessment of therapeutic responses, which is invaluable for tailoring subsequent treatments. It offers a "second opportunity" for patients who do not respond to initial treatment, thereby optimizing their management plan [1]. Moreover, this approach reduces the overall treatment burden by potentially decreasing the extent of surgery required, which can enhance quality of life post-treatment [1].

In the context of novel therapeutic agents, neoadjuvant settings serve as a powerful platform for testing new drugs and combinations. The neoadjuvant phase enables researchers to evaluate the efficacy of experimental therapies more rapidly and with fewer patients compared to traditional adjuvant trials. For instance, the application of immune checkpoint blockade (ICB) in neoadjuvant therapy has shown promise in enhancing systemic anti-tumor immunity, thus providing a unique opportunity to identify biomarkers that predict responses to ICB [2]. This is crucial for refining treatment strategies and improving patient outcomes [2].

The growing body of evidence suggests that neoadjuvant therapies can lead to significant improvements in survival rates and recurrence reduction across various cancer types, including breast, lung, and genitourinary cancers. In particular, neoadjuvant immunotherapy has gained traction as a standard treatment approach, reflecting its evolving role in the therapeutic landscape [5]. The ongoing development of biomarker-stratified trials is expected to enhance the precision of neoadjuvant therapies, ensuring that the right patients receive the right treatments [4].

Future directions in neoadjuvant therapy will likely focus on integrating novel agents with existing therapies, optimizing treatment regimens based on individual tumor biology, and enhancing patient selection through robust biomarker identification. The aim will be to maximize therapeutic efficacy while minimizing adverse effects, ultimately leading to improved quality of life and survival outcomes for patients undergoing cancer treatment.

6.2 Biomarkers for Patient Selection ​

Neoadjuvant therapy has emerged as a pivotal strategy in cancer treatment, particularly for patients with locally advanced malignancies. This approach offers several advantages that contribute to improved treatment outcomes, which are increasingly supported by ongoing research and clinical trials.

One of the primary benefits of neoadjuvant therapy is its ability to target micrometastatic disease before surgical intervention. This preoperative treatment can lead to a reduction in tumor size, facilitating surgical resection and potentially allowing for less extensive surgeries, such as breast-conserving procedures instead of mastectomy in breast cancer patients [25]. Furthermore, the administration of therapies before surgery enables clinicians to assess the tumor's response to treatment in real-time, providing critical prognostic information. For instance, patients achieving a pathological complete response (pCR) after neoadjuvant chemotherapy demonstrate significantly lower recurrence risks compared to those with residual disease [37].

The integration of biomarker testing into neoadjuvant therapy has been instrumental in optimizing patient selection and personalizing treatment plans. Biomarkers such as programmed death-ligand 1 (PD-L1) expression and epidermal growth factor receptor (EGFR) mutations guide therapeutic decisions, enhancing the likelihood of favorable outcomes [38]. Additionally, the identification of predictive biomarkers can help determine which patients are most likely to benefit from specific neoadjuvant treatments, thereby improving the efficacy of the therapeutic approach [39].

In the context of breast cancer, neoadjuvant therapy trials have accelerated drug development and provided insights into the biology of tumors. This has been particularly evident in the case of HER2-positive breast cancers, where dual-agent HER2 blockade in the neoadjuvant setting has resulted in higher pCR rates, suggesting a potential for improved long-term survival [3]. However, challenges remain in identifying reliable biomarkers that can predict treatment responses across various cancer types. Ongoing research is focusing on standardizing protocols for biomarker validation and clinical implementation, which is essential for maximizing the benefits of neoadjuvant therapies [39].

Moreover, the future of neoadjuvant therapy lies in the continued exploration of innovative treatment combinations and the refinement of patient selection processes. As clinical trials expand, there is an urgent need to enhance collaboration between academia and the pharmaceutical industry to build comprehensive databases linking biomarker profiles to patient outcomes. This data-driven approach will facilitate the development of precision neoadjuvant therapies tailored to individual patient characteristics [40].

In conclusion, neoadjuvant therapy represents a significant advancement in cancer treatment, improving surgical outcomes and providing a platform for evaluating therapeutic efficacy through biomarker-guided patient selection. The ongoing evolution of this therapeutic strategy holds promise for enhancing survival rates and optimizing treatment pathways for patients with various malignancies.

6.3 Personalized Neoadjuvant Strategies ​

Neoadjuvant therapy has emerged as a pivotal approach in cancer treatment, particularly for breast cancer and various other malignancies. It involves administering treatment prior to surgery, with the goal of downstaging tumors, improving surgical outcomes, and providing valuable prognostic information. The following points highlight how neoadjuvant therapy improves cancer treatment outcomes and its future directions toward personalized strategies.

Neoadjuvant therapy offers several clinical advantages. It allows for the assessment of tumor response to treatment in vivo, which can guide subsequent adjuvant therapy decisions. Achieving a pathological complete response (pCR) is often correlated with improved long-term survival, especially in aggressive subtypes such as HER2-positive and triple-negative breast cancers (Colomer et al., 2019; Topalian et al., 2023). Moreover, neoadjuvant therapy can increase the rate of breast-conserving surgeries, as it may shrink tumors to a size that allows for less invasive surgical options (Moreno-Aspitia, 2012).

The clinical efficacy of neoadjuvant therapies has been shown to be equivalent to adjuvant therapies, with the added benefits of potentially reduced treatment durations and fewer patients needed for clinical trials to achieve statistical significance (De Mattos-Arruda et al., 2016). For instance, neoadjuvant chemotherapy has been successfully employed in locally advanced breast cancer, demonstrating comparable outcomes to adjuvant therapy while facilitating organ preservation (Thompson & Moulder-Thompson, 2012).

Future directions in neoadjuvant therapy focus on personalizing treatment strategies based on individual tumor biology. Recent advances in molecular profiling and biomarker identification are enabling more tailored approaches. For example, understanding the genetic and molecular characteristics of tumors can help in selecting appropriate neoadjuvant therapies that are more likely to be effective for specific patient populations (Hyder et al., 2021). This is particularly relevant as emerging data suggests that the response to neoadjuvant immunotherapy can vary significantly among different cancer types, highlighting the importance of refining treatment based on individual patient profiles (Awada et al., 2025).

Furthermore, ongoing research is investigating the use of combination therapies in the neoadjuvant setting. Neoadjuvant immune checkpoint blockade (ICB) has shown promise in enhancing anti-tumor immunity and may offer a unique opportunity to identify biomarkers associated with treatment response and resistance (Topalian et al., 2023). The integration of novel agents and treatment modalities, along with comprehensive correlative studies, will be crucial in optimizing neoadjuvant strategies.

In conclusion, neoadjuvant therapy represents a significant advancement in cancer treatment, improving surgical outcomes and providing critical insights into tumor biology. As research progresses, the focus will shift toward personalized neoadjuvant strategies that leverage molecular profiling and novel therapeutic combinations to enhance treatment efficacy and patient outcomes. The integration of these approaches will likely redefine the standard of care in the neoadjuvant setting across various cancer types.

7 Conclusion ​

Neoadjuvant therapy has significantly transformed the landscape of cancer treatment by enhancing surgical outcomes, improving long-term survival rates, and providing critical insights into tumor biology. The primary findings highlight its ability to downstage tumors, eliminate micrometastases, and allow for real-time assessment of treatment responses. As a result, neoadjuvant therapy not only facilitates more successful surgical interventions but also opens avenues for personalized treatment strategies tailored to individual patient profiles. Current research emphasizes the importance of integrating novel therapeutic agents and biomarker identification to optimize patient selection and treatment efficacy. Despite the challenges of treatment-related toxicity and variability in patient responses, the future of neoadjuvant therapy looks promising, with ongoing advancements aimed at refining therapeutic regimens and enhancing patient outcomes. Ultimately, the continuous evolution of neoadjuvant strategies holds the potential to redefine cancer management, paving the way for improved survival and quality of life for patients across various malignancies.

References ​

  • [1] Ramon Colomer;Cristina Saura;Pedro Sánchez-Rovira;Tomás Pascual;Isabel T Rubio;Octavio Burgués;Lourdes Marcos;César A Rodríguez;Miguel Martín;Ana Lluch. Neoadjuvant Management of Early Breast Cancer: A Clinical and Investigational Position Statement.. The oncologist(IF=4.2). 2019. PMID:30710068. DOI: 10.1634/theoncologist.2018-0228.
  • [2] Suzanne L Topalian;Patrick M Forde;Leisha A Emens;Mark Yarchoan;Kellie N Smith;Drew M Pardoll. Neoadjuvant immune checkpoint blockade: A window of opportunity to advance cancer immunotherapy.. Cancer cell(IF=44.5). 2023. PMID:37595586. DOI: 10.1016/j.ccell.2023.07.011.
  • [3] Leticia De Mattos-Arruda;Ronglai Shen;Jorge S Reis-Filho;Javier Cortés. Translating neoadjuvant therapy into survival benefits: one size does not fit all.. Nature reviews. Clinical oncology(IF=82.2). 2016. PMID:27000962. DOI: 10.1038/nrclinonc.2016.35.
  • [4] Sujit S Nair;Dimple Chakravarty;Vaibhav Patel;Nina Bhardwaj;Ashutosh K Tewari. Genitourinary cancer neoadjuvant therapies: current and future approaches.. Trends in cancer(IF=17.5). 2023. PMID:37684128. DOI: 10.1016/j.trecan.2023.07.011.
  • [5] Gil Awada;Tina Cascone;Michiel S van der Heijden;Christian U Blank;Marleen Kok;Myriam Chalabi. The rapidly evolving paradigm of neoadjuvant immunotherapy across cancer types.. Nature cancer(IF=28.5). 2025. PMID:40555863. DOI: 10.1038/s43018-025-00990-7.
  • [6] Alvaro Moreno-Aspitia. Neoadjuvant therapy in early-stage breast cancer.. Critical reviews in oncology/hematology(IF=5.6). 2012. PMID:21616677. DOI: 10.1016/j.critrevonc.2011.04.013.
  • [7] Tara Hyder;Saveri Bhattacharya;Kristine Gade;Azadeh Nasrazadani;Adam M Brufsky. Approaching Neoadjuvant Therapy in the Management of Early-Stage Breast Cancer.. Breast cancer (Dove Medical Press)(IF=3.4). 2021. PMID:33833568. DOI: 10.2147/BCTT.S273058.
  • [8] Yi Li;Ji Wang;Xiaowei Ma;Li Tan;Yanli Yan;Chaofan Xue;Beina Hui;Rui Liu;Hailin Ma;Juan Ren. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer.. International journal of biological sciences(IF=10.0). 2016. PMID:27489505. DOI: 10.7150/ijbs.15438.
  • [9] Katharina Pachmann;Oumar Camara;Andreas Kavallaris;Uwe Schneider;Stefanie Schünemann;Klaus Höffken. Quantification of the response of circulating epithelial cells to neodadjuvant treatment for breast cancer: a new tool for therapy monitoring.. Breast cancer research : BCR(IF=5.6). 2005. PMID:16280045. DOI: 10.1186/bcr1328.
  • [10] Huiru Zhang;Longyun Ye;Xianjun Yu;Kaizhou Jin;Weiding Wu. Neoadjuvant therapy alters the immune microenvironment in pancreatic cancer.. Frontiers in immunology(IF=5.9). 2022. PMID:36225934. DOI: 10.3389/fimmu.2022.956984.
  • [11] Vladimir M Perelmuter;Liubov A Tashireva;Olga E Savelieva;Evgeny V Denisov;Evgeniya V Kaigorodova;Marina V Zavyalova;Nadezhda V Cherdyntseva. Mechanisms behind prometastatic changes induced by neoadjuvant chemotherapy in the breast cancer microenvironment.. Breast cancer (Dove Medical Press)(IF=3.4). 2019. PMID:31308736. DOI: 10.2147/BCTT.S175161.
  • [12] Omar Bushara;Jerica Tidwell;James R Wester;John Miura. The Current State of Neoadjuvant Therapy in Resectable Advanced Stage Melanoma.. Cancers(IF=4.4). 2023. PMID:37444454. DOI: 10.3390/cancers15133344.
  • [13] L P Faber. Current status of neoadjuvant therapy for non-small cell lung cancer.. Chest(IF=8.6). 1994. PMID:7988263. DOI: 10.1378/chest.106.6_supplement.355s.
  • [14] Tufia C Haddad;Matthew P Goetz. Landscape of neoadjuvant therapy for breast cancer.. Annals of surgical oncology(IF=3.5). 2015. PMID:25727557. DOI: 10.1245/s10434-015-4405-7.
  • [15] Carmen Mota Reyes;Steffen Teller;Alexander Muckenhuber;Björn Konukiewitz;Okan Safak;Wilko Weichert;Helmut Friess;Güralp O Ceyhan;Ihsan Ekin Demir. Neoadjuvant Therapy Remodels the Pancreatic Cancer Microenvironment via Depletion of Protumorigenic Immune Cells.. Clinical cancer research : an official journal of the American Association for Cancer Research(IF=10.2). 2020. PMID:31585935. DOI: 10.1158/1078-0432.CCR-19-1864.
  • [16] Gaiane M Rauch;Beatriz Elena Adrada;Henry Mark Kuerer;Raquel F D van la Parra;Jessica W T Leung;Wei Tse Yang. Multimodality Imaging for Evaluating Response to Neoadjuvant Chemotherapy in Breast Cancer.. AJR. American journal of roentgenology(IF=6.1). 2017. PMID:27809573. DOI: 10.2214/AJR.16.17223.
  • [17] Huan Wang;Xiaoyun Mao. Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer.. Drug design, development and therapy(IF=5.1). 2020. PMID:32606609. DOI: 10.2147/DDDT.S253961.
  • [18] Valerie M Nelson;Al B Benson. Pathological complete response after neoadjuvant therapy for rectal cancer and the role of adjuvant therapy.. Current oncology reports(IF=5.0). 2013. PMID:23381584. DOI: 10.1007/s11912-013-0297-5.
  • [19] Zhen Yu;Yuying Hao;Yuhua Huang;Ling Ling;Xigang Hu;Simiao Qiao. Radiotherapy in the preoperative neoadjuvant treatment of locally advanced rectal cancer.. Frontiers in oncology(IF=3.3). 2023. PMID:38074690. DOI: 10.3389/fonc.2023.1300535.
  • [20] Yan Lin;Shou-Feng Wang;Huan-Wei Liang;Yang Liu;Wei Huang;Xin-Bin Pan. Preoperative radiotherapy in patients with locally advanced esophageal squamous cell carcinoma: a narrative review.. Frontiers in oncology(IF=3.3). 2025. PMID:40766330. DOI: 10.3389/fonc.2025.1613954.
  • [21] F Klevebro;G Alexandersson von Döbeln;N Wang;G Johnsen;A-B Jacobsen;S Friesland;I Hatlevoll;N I Glenjen;P Lind;J A Tsai;L Lundell;M Nilsson. A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction.. Annals of oncology : official journal of the European Society for Medical Oncology(IF=65.4). 2016. PMID:26782957. DOI: 10.1093/annonc/mdw010.
  • [22] E L Trimble;R S Ungerleider;J A Abrams;R S Kaplan;E G Feigal;M A Smith;C L Carter;M A Friedman. Neoadjuvant therapy in cancer treatment.. Cancer(IF=5.1). 1993. PMID:8242583. DOI: 10.1002/1097-0142(19931201)72:11+<3515::aid-cncr2820721619>3.0.co;2-a.
  • [23] Sara K Daniel;Brian D Badgwell;Sophia K McKinley;Vivian E Strong;George A Poultsides. Great Debate: Chemoradiation Should be Added to Chemotherapy as a Neoadjuvant Treatment Strategy for Resectable Gastric Adenocarcinoma.. Annals of surgical oncology(IF=3.5). 2024. PMID:37865940. DOI: 10.1245/s10434-023-14378-3.
  • [24] Hirofumi Shibata;Shin Saito;Ravindra Uppaluri. Immunotherapy for Head and Neck Cancer: A Paradigm Shift From Induction Chemotherapy to Neoadjuvant Immunotherapy.. Frontiers in oncology(IF=3.3). 2021. PMID:34552878. DOI: 10.3389/fonc.2021.727433.
  • [25] Domingos Sávio do Rego Lins Junior;Beatriz Mendes Awni Cidale;Ana Zelia Leal Pereira;Jacqueline Nunes de Menezes;Eduardo Bertolli;Francisco Aparecido Belfort;Rodrigo Ramella Munhoz. Emerging Indications for Neoadjuvant Systemic Therapies in Cutaneous Malignancies.. Medical sciences (Basel, Switzerland)(IF=4.4). 2024. PMID:39189198. DOI: 10.3390/medsci12030035.
  • [26] Xi Chen;Kewei Ma. Neoadjuvant Therapy in Lung Cancer: What Is Most Important: Objective Response Rate or Major Pathological Response?. Current oncology (Toronto, Ont.)(IF=3.4). 2021. PMID:34677268. DOI: 10.3390/curroncol28050350.
  • [27] Tong Chen;Fang Liu. Neoadjuvant immunotherapy in early-stage NSCLC: navigating biomarker dilemmas and special population challenges.. Lung cancer (Amsterdam, Netherlands)(IF=4.4). 2025. PMID:40409027. DOI: 10.1016/j.lungcan.2025.108588.
  • [28] Avo Artinyan;Daniel A Anaya;Shaun McKenzie;Joshua D I Ellenhorn;Joseph Kim. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma.. Cancer(IF=5.1). 2011. PMID:21523715. DOI: 10.1002/cncr.25763.
  • [29] Wilhelm Leijonmarck;Fredrik Mattsson;Jesper Lagergren. Neoadjuvant chemotherapy in relation to long-term mortality in individuals cured of gastric adenocarcinoma.. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association(IF=5.1). 2025. PMID:39387985. DOI: 10.1007/s10120-024-01558-7.
  • [30] A M Thompson;S L Moulder-Thompson. Neoadjuvant treatment of breast cancer.. Annals of oncology : official journal of the European Society for Medical Oncology(IF=65.4). 2012. PMID:22987968. DOI: 10.1093/annonc/mds324.
  • [31] David Bunting;Richard Berrisford;Tim Wheatley;Lee Humphreys;Arun Ariyarathenam;Grant Sanders. Prospective cohort study of neoadjuvant therapy toxicity in the treatment of oesophageal adenocarcinoma.. International journal of surgery (London, England)(IF=10.1). 2018. PMID:29455047. DOI: 10.1016/j.ijsu.2018.02.023.
  • [32] P Chollet;S Charrier;E Brain;H Curé;I van Praagh;V Feillel;M de Latour;J Dauplat;J L Misset;J P Ferrière. Clinical and pathological response to primary chemotherapy in operable breast cancer.. European journal of cancer (Oxford, England : 1990)(IF=7.1). 1997. PMID:9291806. DOI: 10.1016/s0959-8049(97)00038-5.
  • [33] Rossi Lorenzo;Francesco Meani;Claudio Longhitano;Rosaria Carciotto;Katia Lanzafame;Nicola Inzerilli;Paolo Vigneri. The optimal timing between neoadjuvant therapy and surgery of breast cancer: A brief systematic review of the literature.. Critical reviews in oncology/hematology(IF=5.6). 2023. PMID:36746358. DOI: 10.1016/j.critrevonc.2023.103921.
  • [34] Sibylle Loibl;Carsten Denkert;Gunter von Minckwitz. Neoadjuvant treatment of breast cancer--Clinical and research perspective.. Breast (Edinburgh, Scotland)(IF=7.9). 2015. PMID:26387601. DOI: .
  • [35] Christiane Matuschek;Danny Jazmati;Edwin Bölke;Bálint Tamaskovics;Stefanie Corradini;Wilfried Budach;David Krug;Svjetlana Mohrmann;Eugen Ruckhäberle;Tanja Fehm;Carolin Nestle Krämling;Markus Dommach;Jan Haussmann. Post-Neoadjuvant Treatment Strategies in Breast Cancer.. Cancers(IF=4.4). 2022. PMID:35267554. DOI: 10.3390/cancers14051246.
  • [36] Gregory T Wolf. Integrating surgery into treatment paradigms for organ preservation: tailoring treatment to biology improves outcomes.. International journal of radiation oncology, biology, physics(IF=6.5). 2007. PMID:17848290. DOI: 10.1016/j.ijrobp.2007.05.071.
  • [37] Yanjie Shuai;Li Ma. Prognostic value of pathologic complete response and the alteration of breast cancer immunohistochemical biomarkers after neoadjuvant chemotherapy.. Pathology, research and practice(IF=3.2). 2019. PMID:30501932. DOI: 10.1016/j.prp.2018.11.003.
  • [38] Luca Bertolaccini;Monica Casiraghi;Claudia Bardoni;Cristina Diotti;Matteo Chiari;Antonio Mazzella;Filippo de Marinis;Lorenzo Spaggiari. Revamping Non-Small Cell Lung Cancer Treatments in Stages II and III: Preparing Healthcare for Cutting-Edge Immuno-Oncology Regimens.. Cancers(IF=4.4). 2024. PMID:39199613. DOI: 10.3390/cancers16162842.
  • [39] Emma Boydell;Jose L Sandoval;Olivier Michielin;Michel Obeid;Alfredo Addeo;Alex Friedlaender. Neoadjuvant Immunotherapy: A Promising New Standard of Care.. International journal of molecular sciences(IF=4.9). 2023. PMID:37511609. DOI: 10.3390/ijms241411849.
  • [40] Elisa Agostinetto;Joseph Gligorov;Martine Piccart. Systemic therapy for early-stage breast cancer: learning from the past to build the future.. Nature reviews. Clinical oncology(IF=82.2). 2022. PMID:36253451. DOI: 10.1038/s41571-022-00687-1.

MaltSci Intelligent Research Services ​

Search for more papers on MaltSci.com ​

Neoadjuvant Therapy · Cancer Treatment · Surgical Outcomes · Personalized Medicine · Biomarkers

© 2025 MaltSci