Potential Impact of Preoperative Circulating Biomarkers on Individual Escalating/de-Escalating Strategies in Early Breast Cancer

SIMPLE SUMMARY: Advancements in molecular technologies have extended the potential role of circulating biomarkers in diagnosis, disease monitoring, and outcome prediction. Research is working towards personalized treatment in early breast cancer patients, and tools for intensification/de-intensification strategies are needed to guide clinicians’ choices. In this review, we explore the current developments of promising biomarkers in early breast cancer for cancer detection and tailoring neoadjuvant therapies. ABSTRACT: The research on non-invasive circulating biomarkers to guide clinical decision is in wide expansion, including the earliest disease settings. Several new intensification/de-intensification strategies are approaching clinical practice, personalizing the treatment for each patient. Moreover, liquid biopsy is revealing its potential with multiple techniques and studies available on circulating biomarkers in the preoperative phase. Inflammatory circulating cells, circulating tumor cells (CTCs), cell-free DNA (cfDNA), circulating tumor DNA (ctDNA), and other biological biomarkers are improving the armamentarium for treatment selection. Defining the escalation and de-escalation of treatments is a mainstay of personalized medicine in early breast cancer. In this review, we delineate the studies investigating the possible application of these non-invasive tools to give a more enlightened approach to escalating/de-escalating strategies in early breast cancer.