Pre-operative (neoadjuvant) chemotherapy trial confirms that sequencing of chemotherapy drugs has a significant impact on response to chemotherapy.

Trials of new chemotherapy drugs for breast cancer can take many years to provide information regarding their efficacy, and can delay the introduction of new drugs that can help to further reduce the number of deaths from breast cancer.

Pre-operative or neoadjuvant chemotherapy trials can be performed more quickly and pathological assessment of the surgical specimen allows the response to chemotherapy to be compared between different drugs. These neoadjuvant trials therefore allow more rapid assessment of new chemotherapy drugs or drug combinations.

 The results from the Neo-tAnGo trial were published in the Lancet Oncology in December 20131 and reported two main findings. Firstly, the addition of Gemcitabine to current chemotherapy combinations did not improve the response to chemotherapy. The main finding however was that by giving taxane chemotherapy before anthracycline chemotherapy, complete eradication of the breast cancer was increased from 15% to 20%.  It is likely that this will lead to improved long term survival for patients with an improved response to chemotherapy before surgery. Professor Gordon Wishart was part of the Neo-tAnGo trial management group.

1. Earl HM, Vallier AL, Hiller L et al . Neoadjuvant sequential epirubicin, cyclophosphamide, and paclitaxel, with or without gemcitabine, for women with high risk early breast cancer (Neo-tAnGo): an open-label, 2 x 2 factorial randomised phase 3 trial. Lancet Oncol 2014; 15: 201-12.