Neoadjuvant endocrine treatment in early breast cancer: An overlooked alternative?
Journal:
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
PMID:
26776766
Abstract
During the last decade neoadjuvant endocrine therapy (NET) has moved from being reserved for elderly and frail non-chemotherapy candidates to a primary systemic modality in selected patients with hormone sensitive breast cancer. Neoadjuvant hormonal treatment in patients with hormone receptor positive, HER-2 negative early breast cancer is proven to be an effective and safe option; it is associated with a higher rate of breast conserving surgery (BCS), may reduce the need for adjuvant chemotherapy and enables a delay of surgery for medical or practical reasons. Clinical responses range from 13% to 100% with at least 3 months of NET. Methods of assessing response should include MRI of the breast, particularly in lobular tumours. In studies comparing tamoxifen with aromatase inhibitors (AI), AI proved to be superior in terms of tumour response and rates of BCS. Change in Ki67 is accepted as a validated endpoint for comparing endocrine neoadjuvant agents. Levels of Ki67 during treatment are more closely related to long-term prognosis than pretreatment Ki67. Neoadjuvant endocrine therapy provides a unique opportunity for studies of endocrine responsiveness and the development of new experimental drugs combined with systemic hormonal treatment.
Authors
Keywords
Adult
Age Factors
Aged
Antineoplastic Agents, Hormonal
Aromatase Inhibitors
Breast Neoplasms
Early Detection of Cancer
Female
Humans
Magnetic Resonance Imaging
Mastectomy, Segmental
Middle Aged
Neoadjuvant Therapy
Neoplasm Invasiveness
Neoplasm Staging
Prognosis
Randomized Controlled Trials as Topic
Receptor, ErbB-2
Risk Factors
Treatment Outcome