Editor’s Note: The 20th Shanghai International Breast Cancer Symposium (SIBCS), hosted by the Shanghai Anti-Cancer Association and the Breast Cancer Committee of the China Anti-Cancer Association, was held on November 13–15, 2025. During the “Hundred Schools of Thought” session, Professor Kun Wang from Guangdong Provincial People’s Hospital delivered an academic presentation titled “Guangdong Experience: Exploring Neoadjuvant Therapy in the New Era.” Following his talk, Oncology Frontier invited Professor Wang to elaborate on his team’s latest clinical progress in breast cancer neoadjuvant therapy, and to share his insights on the evolving role of ADCs and major challenges ahead. 01
Oncology Frontier: Your SIBCS presentation focused on “Exploration of Neoadjuvant Therapy in the New Era.” Could you summarize the latest progress from your team in this field?
Professor Kun Wang:
It was an honor to present our recent work at SIBCS. Our group has been conducting multiple studies across early breast cancer—including neoadjuvant therapy, adjuvant therapy—and advanced disease. For this presentation, we narrowed the discussion to the neoadjuvant setting, hence the theme of a “new era.”
The “new era” signifies two key shifts:
- Neoadjuvant therapy is no longer simply the early implementation of adjuvant therapy. Today we can personalize treatment during the neoadjuvant stage using multiple tools.
- Postoperative treatment is now guided by residual disease assessment. Whether a patient achieves pathological complete response (pCR) determines eligibility for therapy escalation, thereby maximizing long-term benefit.
Together, these innovations allow more precise upfront treatment and improved survival through tailored adjuvant intensification.
Our team has carried out a series of studies in this direction. For example, the NeoCART trial was the first to introduce platinum-based chemotherapy into neoadjuvant treatment for triple-negative breast cancer (TNBC). Results showed a 22.4% increase in pCR when TC (docetaxel + carboplatin) was compared with the standard EC–T regimen (pCR: 61.4% vs 38.6%). This study has since been incorporated into the NCCN Guidelines (2022.V1) under the neoadjuvant/adjuvant recommendations.
Another of our key projects, the neoCARHP study, was selected as an LBA at this year’s ASCO. In the presentation (Abstract LBA500), we reported that in early HER2-positive breast cancer, a de-escalated THP regimen (docetaxel + trastuzumab + pertuzumab) was non-inferior to the TCbH regimen (docetaxel + carboplatin + trastuzumab) in terms of pCR (64.1% vs 65.9%), with lower toxicity. This firmly establishes THP as an important neoadjuvant option in early HER2-positive disease. We expect these data will influence updates in clinical practice.
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Oncology Frontier: Neoadjuvant treatment for TNBC is evolving from pure chemotherapy to IO+chemotherapy and risk-adapted de-escalation strategies. In your view, what should be the next key directions? With Trop-2 ADCs showing strong efficacy in metastatic TNBC, do you foresee them replacing chemotherapy in the neoadjuvant setting?
Professor Kun Wang:
The future of TNBC neoadjuvant therapy will move along two parallel directions:
1. De-escalation (for low-risk or good-prognosis patients)
KEYNOTE-522 established chemo-immunotherapy as the current standard. However, it uses an intensive four-drug chemotherapy backbone, raising the question: Do all early TNBC patients truly need such aggressive regimens? This remains an important area for refinement.
2. Escalation (for high-risk patients)
For patients with heavy tumor burden or extensive nodal involvement, even the four-drug IO-chemo combination may not be sufficient. Here, ADC-based intensification represents a major opportunity.
Given that Trop-2 ADCs (such as sacituzumab govitecan) have demonstrated meaningful superiority over chemotherapy in metastatic TNBC—and continue to produce encouraging results—we expect ADCs to enter the neoadjuvant space.
Combination approaches (ADC + immunotherapy or ADC + chemotherapy) will be a key developmental direction.
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Oncology Frontier: In HR-positive and “triple-positive” breast cancer, what therapeutic strategies or investigational agents are most likely to advance the neoadjuvant field? What key challenges remain?
Professor Kun Wang:
Across all breast cancer subtypes—HER2-positive, HR-positive, triple-positive, and TNBC—the future direction is precision subtyping.
This means:
- Selecting drugs based on tumor burden,
- And more importantly, on biologically refined molecular subtypes.
For example, within HER2-positive disease, we are already distinguishing “pure HER2-positive” tumors from triple-positive breast cancer, and these groups may require different therapeutic approaches. Such subtype-based treatment selection is the future trend.
Meanwhile, several ADCs are rapidly expanding from late-stage to early-stage indications. I believe they will play an increasingly important role in neoadjuvant therapy. The main challenges will be:
- identifying the optimal patient population,
- balancing escalation vs de-escalation,
- and integrating ADCs into existing multimodal treatment frameworks.
Professor Kun Wang
Vice President, Guangdong Provincial People’s Hospital Cancer Center
