Perioperative Drug Management of Systemic Therapies in Breast Cancer: A Literature Review and Treatment Recommendations.

Abstract

Breast cancer accounts for about 30% of all new female cancers each year, and its incidence is increasing 0.6% per year. An enhanced understanding of the molecular mechanisms of carcinogenesis has led to the development of constantly evolving strategies for local and systemic therapies. Perioperative chemotherapy, immunotherapy, and endocrine therapy play pivotal roles in the overall treatment plan. Guidelines on the appropriate use of these drugs in patients undergoing extirpative breast surgery and/or breast reconstruction are lacking. Clear indications for the management of systemic therapies relative to the timing of surgery is crucial to ensure consistent treatment outcomes and to minimize complications. Our purpose is to propose evidence-based recommendations to optimize the perioperative management of systemic therapies in patients undergoing breast cancer surgery and breast reconstructive surgery. In this review, we outline the basic tenets of breast cancer therapies, provide an overview on wound-healing principles, delineate relevant pharmacodynamic concepts, summarize literature and pharmacologic data from various preclinical studies and clinical trials, and propose treatment recommendations. Synopsis: This review proposes evidence-based recommendations regarding systemic therapies management for outcome optimization in the perioperative period in breast cancer patients.