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Preoperative chemotherapy in operable breast cancer. The influence of timing FEC in relation to surgery.

The goal of all new strategies of breast cancer treatment is to improve the likelihood of cure and to lessen the physical and psychological sequelae of mastectomy. Adjuvant chemotherapy has been shown to improve survival curves in most patient subgroups, although the benefit is far from optimal. In the absence of more effective new drugs, it is important to continue to explore the optimal timing for chemotherapy in relation to surgery. European Organization for Research and Treatment of Cancer (EORTC) protocol 10854 was designed to answer the question of whether an anthracycline-containing regimen, given at the earliest possible time interval after surgery, would have a significant impact on survival compared with a control group. This reduction in delay of chemotherapy proved a feasible approach and 2795 patients were randomised. The ongoing Pre-Operative Chemotherapy in Operable Breast Cancer (POCOB) study (EORTC 10902) addresses the important question of whether reversal of the treatment modalities, i.e. starting chemotherapy 12 weeks before surgery, will definitely permit more breast conserving therapy. This regimen is compared with the same therapy initiated shortly (perioperatively) after surgery.