Neoadjuvant Therapy

What is neoadjuvant therapy?

Neoadjuvant therapy is a type of cancer treatment that you receive before you have surgery to remove a cancerous tumor. Your oncologist may call this treatment perioperative therapy or induction therapy. Neoadjuvant therapy shrinks tumors so they’re easier to remove. In some cases, neoadjuvant therapy eliminates tumors, so you don’t need surgery.

Types of neoadjuvant therapy

There are several types of neoadjuvant therapies:

• Chemotherapy. Chemotherapy destroys cancer cells before they can multiply and make tumors grow.
• Hormone therapy. Some kinds of cancer need hormones to grow, multiply and spread. Neoadjuvant hormone therapy cuts off that supply so cancerous tumors stop growing.
• Immunotherapy. Monoclonal antibody therapy is an example of immunotherapy that you may receive before surgery.
• Radiation therapy. This treatment typically uses high-powered X-rays to kill cancer cells.

Your oncology care team may use different types of neoadjuvant therapy to treat the same kind of cancer. For example, they may combine chemotherapy and radiation (neoadjuvant chemoradiation).

While specific treatment varies, all neoadjuvant therapies involve treatment that may last weeks, months or up to a year before you have surgery. Most people have surgery within a month after completing treatment.

What conditions are treated with neoadjuvant therapy?

Oncologists use neoadjuvant therapy for more than a dozen kinds of cancer, including common cancers like breast cancer, colon cancer, lung cancer, prostate cancer and rectal cancer.

Breast cancer

Oncologists may use chemotherapy, Immunotherapy and/or hormone therapy as neoadjuvant therapy for:

• Inflammatory breast cancer
• Early-stage ER-positive breast cancer
• Some forms of HER2-positive breast cancer
• Some forms of triple-negative breast cancer

Colon cancer

People with colon cancer that’s spread (metastasized) to their liver may receive chemotherapy before surgery to remove a tumor.

Lung cancer

Chemotherapy is a common type of neoadjuvant therapy for non-small cell lung cancer that’s spread (metastasized). Oncologists may also use chemoradiation. Researchers are also evaluating immunotherapy as a potential neoadjuvant therapy.

Prostate cancer

Oncologists may treat some forms of metastatic prostate cancer with hormone therapy. The hormone testosterone boosts cancer cell growth. Hormone therapy in prostate cancer works by reducing your testosterone levels or keeping testosterone from reaching cancer cells. Your oncologist may combine hormone therapy with radiation therapy.

Rectal cancer

Radiation therapy combined with chemotherapy is a common treatment for metastatic rectal cancer. Another treatment is total neoadjuvant therapy. This treatment is chemotherapy followed by chemoradiation.

What are the benefits of neoadjuvant therapy?

Neoadjuvant therapy has several benefits:

• Shrinks tumors. The treatment can turn large tumors into smaller tumors that are easier to remove. For example, if you have breast cancer, shrinking a tumor may mean your surgeon oncologist can remove your tumor with a lumpectomy instead of a mastectomy.
• Eliminates some tumors. Neoadjuvant therapy may eliminate small tumors so you don’t need surgery.
• Easier recovery. Your surgeon oncologist can use smaller incisions (cuts) to get to the tumor. Smaller incisions may lead to an easier recovery from surgery.
• Evaluates cancer treatment. Neoadjuvant therapy can help your oncology team find out if a specific cancer treatment is effective. For example, if you’re receiving a specific type of chemotherapy before breast cancer surgery, your oncologist can see how quickly that chemotherapy works to shrink the tumor in your breast.
• Reduces risk of micrometastases. Micro metastases are very tiny cancer cells that break off from a tumor and move to other areas of your body. They’re so tiny that tests can’t detect them. Neoadjuvant therapy that affects your entire body gets rid of micrometastases.
• Reduces risk of recurrence. Some research suggests neoadjuvant therapy may keep certain cancers from coming back (recurring).

Neoadjuvant therapy side effects

Side effects vary depending on the treatment type. Some common side effects are:

• Anorexia nervosa
• Diarrhea
• Fatigue
• Loss of taste (ageusia)
• Nausea and vomiting

You may be worried about treatment side effects. Your oncologist will explain how each treatment could affect you. More importantly, they’ll explain what they’ll do to help ease treatment side effects, including providing palliative care. Palliative care is specialized treatment for people with serious illnesses. In palliative care, you receive treatment to ease your symptoms and manage side effects.

What’s the outlook for cancer treated with neoadjuvant therapy?

The outlook is good as researchers find new ways to use different combinations of cancer treatments as neoadjuvant therapy. For example, one breast cancer clinical trial that combines chemotherapy and an immunotherapy drug doubled the instances where treatment put cancer into remission. Remission means you don’t have symptoms and tests don’t detect signs of cancer.

How successful is neoadjuvant therapy?

Successful treatment varies depending on the type of cancer, cancer stage, treatment type and overall health. But in general, research shows that neoadjuvant therapy:

• Reduces the chance you’ll need surgery to remove a cancerous tumor
• If you do need surgery, increases the chance that surgery and adjuvant (follow-up) therapy will put the condition into remission

When should I see my healthcare provider?

If you’re receiving neoadjuvant therapy, you’ll see your oncologist often so you can ask questions about your treatment, and they can check on your overall health and progress. But there may be times when you have concerns. Don’t hesitate to contact your provider if:

• If you experience treatment side effects that are more intense than you expect or that you can’t manage with medication. For example, talk to your provider if you have nausea and vomiting that disrupts your daily life even after you take medication.
• You notice changes in your body that could be signs that your condition is worsening.

What’s the difference between neoadjuvant therapy and adjuvant therapy?

Both are examples of treatments that support cancer surgery. The difference is neoadjuvant therapy happens before surgery and adjuvant therapy is treatment after cancer surgery.