5.1.1 Indications and Program Recommendations
Neoadjuvant chemotherapy is also known as preoperative chemotherapy.Clinically，neoadjuvant chemotherapy is generally considered for breast cancer patients with large tumors（＞5 cm）or axillary lymph node metastasis.Some patients also have breast-feeding intentions，but patients with a larger volume ratio may also choose preoperative chemotherapy，and surgery will be performed after the tumor is significantly reduced.Most Chinese experts believe that tumors should be greater than 2 cm when HER-2 positive or triple negative is used as a new adjuvant for breast cancer.For the selection of neoadjuvant chemotherapy regimens，the expert I-level recommendation（basic strategy）from 2017 to 2019 is based on anthracyclines combined with purple shirts based on a 2016 prescription for anthracyclines.The efficacy and safety of neoadjuvant therapy for breast cancer［1］，a total of 192 patients with early or local advanced breast cancer receiving anthracycline combined with new adjuvant chemotherapy，the results showed that the effective rate was 84.9%，The complete pathological remission rate was 20.3%，and the anthracycline combined with purple shirt was effective，and adverse reactions were tolerated（mainly myelosuppression，vomiting，musculoskeletal pain，numbness）.This study confirmed the role of anthracyclines in combination with vaginal tract in neoadjuvant chemotherapy for breast cancer.The ankle ring and the purple shirt can be used simultaneously or sequentially，but both the 2018 and 2019 CSCO guidelines will be used simultaneously as a level I recommendation，and the sequential use as a level Ⅱrecommendation.For young and triple-negative breast cancer，BRCA-mutant breast cancer can also be selected for the TP regimen（docetaxel/paclitaxel plus platinum）.(https://www.daowen.com)
Complete pathological remission（pCR）is the final evaluation method for neoadjuvant efficacy.For patients with neoadjuvant chemotherapy，the hormone receptor-positive type should start secretory treatment in time，HER-2 positive type，and start anti-HER-2 in time.Targeted therapy，triple-negative breast cancer，if pCR is not achieved after surgery，in the CSCO guidelines of 2017/2018，it is considered that preoperative staging，pathological cytology，etc.should be considered comprehensively，and capecitabine therapy as postoperative 2B-assisted.The evidence for treatment is recommended.The2017 CREAT-X study［2］included 910 patients with HER-2 negative breast cancer who had residual invasive carcinoma after neoadjuvant chemotherapy.They were randomized to receive capecitabine or control group.The main focus of the study was disease-free survival.（Disease-free survival，DFS），secondary survival（OS），the final analysis showed that the disease-free survival of the capecitabine group was longer than the control group（74.1%vs 67.6%，P=0.01）.The overall survival of the capecitabine group was longer than that of the control group（89.2%vs 83.6%，P=0.01）.In patients with triple-negative disease，the disease-free survival rate of the capecitabine group was 69.8%，while the control group was 56.1%.The overall survival rate was 78.8%versus 70.3%，and hand-foot syndrome was the most common adverse reaction to capecitabine.Based on this study，the 2019 CSCO guidelines clearly stated that for triple-negative breast cancer，neoadjuvant chemotherapy did not reach pCR，and postoperative treatment with 6 to 8 cycles of capecitabine was given.