Neoadjuvant therapy is given to shrink a tumor in advance of the main treatment, which is usually surgery. It is sometimes called preoperative or induction therapy. The most common forms of neoadjuvant therapy are chemotherapy, radiation therapy, and hormone therapy.
By shrinking tumors prior to removal, these treatments can make surgery easier for both the patient and surgeon and may make it possible to remove tumors that otherwise would have been inoperable. Adjuvant therapies, by contrast, are given after surgery to reduce the risk that cancer will come back.
Neoadjuvant therapies like chemotherapy and hormone therapy can also be useful if a tumor has begun to metastasize. This approach makes it possible to treat metastatic cancer cells upfront, rather than having to wait for the patient to recover from surgery.
What types of cancer are treated with neoadjuvant therapy?
A variety of solid tumors can be treated with this approach. It is often used for breast cancer, colon cancer, and lung cancer. For many patients with osteogenic sarcoma, a form of bone cancer, preoperative chemotherapy is standard treatment.
Which patients are eligible for neoadjuvant therapy?
The decision to use neoadjuvant therapy is based on a variety of factors including:
- The type, size, and location of the tumor
- The goals of treatment — to shrink the tumor ahead of surgery, for example, or to ease symptoms or slow tumor growth
- The patient’s ability to tolerate multiple treatments
Can a patient be treated with both neoadjuvant and adjuvant therapy?
In some cases, yes. Neoadjuvant therapy can be used to guide treatment after surgery. If a tumor doesn’t shrink much after neoadjuvant therapy, doctors may decide to use a different type of treatment as adjuvant therapy.
What is some of the latest research in neoadjuvant therapy?
- A recent study by researchers at Dana-Farber and the University of California at Los Angeles found that that patients with recurrent glioblastomas lived nearly twice as long if they received an immunotherapy drug prior to and following surgery, compared to patients who receive the drug only after surgery.
- In a clinical trial, a neoadjuvant therapy consisting of an immune checkpoint inhibitor was well tolerated and, in many cases, caused significant tumor cell death in patients with operable non-small cell lung cancer, Dana-Farber investigators have reported.
- A trial led by Dana-Farber/Brigham Cancer Center researchers found that immunotherapy given before other treatments for oral cavity cancers can produce an immune system response that shrinks the tumors, potentially providing a long-term benefit for patients.
About the Medical Reviewer
Dr. Burstein graduated from Harvard College before earning his MD at Harvard Medical School. He also received a PhD in cellular immunology and a master's degree in the history of science from Harvard. He trained in internal medicine at Massachusetts General Hospital before his oncology fellowship at DFCI. In 1999, he joined the staff of DFCI and Brigham and Women's Hospital, where he is a clinician and clinical investigator in the Breast Oncology Center. Dr. Burstein is an internationally renowned breast cancer expert, who has led and participated in multiple clinical trials, and developed national and international breast cancer treatment guidelines. Recognized as one of the leading breast oncologists, he is a perennial "Top Doctor" in the US for breast cancer care. He teaches students, residents and fellows at Harvard Medical School and Dana-Farber.