Neoadjuvant treatments in patients with breast cancer provide the opportunity for a direct evaluation of treatment effect on tumour size, allow higher rates of conservative surgery and give the chance to tailor systemic treatments after surgery. Patients who achieve a pathological complete response experience better long-term survival, compared to those with residual disease after the completion of neoadjuvant therapy, and those with residual invasive disease at surgery may benefit from additional post-neoadjuvant treatment strategies. Some systemic post-neoadjuvant treatments for patients with residual disease at surgery are already approved in clinical practice (i.e., capecitabine for patients with triple-negative breast cancer, or T-DM1 for patients with HER2-positive disease), and several new strategies are currently under evaluation. The present review discusses the available evidence for the implementation of systemic post-neoadjuvant treatment strategies into clinical practice for patients with early breast cancer, shading light on the pitfalls and limitations of different studies, and summarising data on novel promising treatment strategies that are being explored in clinical trials.

(BELG J MED ONCOL 2022;16(6):262–73)