The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 trial compared the strategy of four cycles of chemotherapy followed by surgery (neoadjuvant) to the strategy of surgery followed by four cycles of the same chemotherapy (adjuvant).

While the former was associated with a higher rate of breast conservation, there was no difference in survival between the two arms.

Patients who achieve a pathologic complete response after neoadjuvant chemotherapy have an improved prognosis; therefore, many clinical trials use the neoadjuvant setting, where response to novel therapies can be monitored in vivo.

Untch M, Konecny GE, Paepke S, von Minckwitz G. Current and future role of neoadjuvant therapy for breast cancer. Breast. 2014; 23:526-537.

Wang-Lopez Q, Chalabi N, Abrial C, et al. Can pathologic complete response (pCR) be used as a surrogate marker of survival after neoadjuvant therapy for breast cancer? Crit Rev Oncol Hematol. 2015;95:88-105.

Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine year results for National Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;30:96-102

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