Multidisciplinary Approach to Neoadjuvant Endocrine Therapy in Breast Cancer: A Comprehensive Review

Reinert, Tomás; Ramalho, Susana; Gonçalves, Rodrigo; Barrios, Carlos H.; Graudenz, Márcia Silveira; Bines, José

doi:10.1055/s-0036-1597579

Cited by 9 publications

(5 citation statements)

References 52 publications

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“…Neoadjuvant ET (NET) is being increasingly studied both as a clinical and as a scientific tool (56, 57). The evaluation of treatment response in vivo is of the highest importance, especially when the disease is still within a “window of curability” (1).…”

Section: Future Perspectivesmentioning

confidence: 99%

Clinical Implications of ESR1 Mutations in Hormone Receptor-Positive Advanced Breast Cancer

Reinert

Saad²,

Barrios

et al. 2017

Front. Oncol.

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Hormone receptor-positive breast cancer is the most frequent breast cancer subtype. Endocrine therapy (ET) targeting the estrogen receptor (ER) pathway represents the main initial therapeutic approach. The major strategies include estrogen deprivation and the use of selective estrogen modulators or degraders, which show efficacy in the management of metastatic and early-stage disease. However, clinical resistance associated with progression of disease remains a significant therapeutic challenge. Mutations of the ESR1 gene, which encodes the ER, have been increasingly recognized as an important mechanism of ET resistance, with a prevalence that ranges from 11 to 39%. The majority of these mutations are located within the ligand-binding domain and result in an estrogen-independent constitutive activation of the ER and, therefore, resistance to estrogen deprivation therapy such as aromatase inhibition. ESR1 mutations, most often detected from liquid biopsies, have been consistently associated with a worse outcome and are being currently evaluated as a potential biomarker to guide therapeutic decisions. At the same time, targeted therapy directed to ESR1-mutated clones is an appealing concept with preclinical and clinical work in progress.

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Section: Future Perspectivesmentioning

confidence: 99%

Clinical Implications of ESR1 Mutations in Hormone Receptor-Positive Advanced Breast Cancer

Reinert

Saad²,

Barrios

et al. 2017

Front. Oncol.

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“…However, the application of personalized treatments could greatly improve opportunities for success in more patients. In general, neoadjuvant chemotherapy shrinks the tumor and is often used to avoid less extensive surgery [ 26 , 27 ] or to treat cancers that are too big to be removed at the time of diagnosis [ 28 , 29 ]. On the other hand, adjuvant chemotherapy is adopted after surgery in an attempt to reduce the risk of BrCa reappearance [ 30 , 31 , 32 , 33 ].…”

Section: Current Brca Therapeuticsmentioning

confidence: 99%

Alternative Splicing in Breast Cancer and the Potential Development of Therapeutic Tools

Martínez-Montiel

Anaya-Ruı́z

Pérez-Santos

et al. 2017

Genes

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Alternative splicing is a key molecular mechanism now considered as a hallmark of cancer that has been associated with the expression of distinct isoforms during the onset and progression of the disease. The leading cause of cancer-related deaths in women worldwide is breast cancer, and even when the role of alternative splicing in this type of cancer has been established, the function of this mechanism in breast cancer biology is not completely decoded. In order to gain a comprehensive view of the role of alternative splicing in breast cancer biology and development, we summarize here recent findings regarding alternative splicing events that have been well documented for breast cancer evolution, considering its prognostic and therapeutic value. Moreover, we analyze how the response to endocrine and chemical therapies could be affected due to alternative splicing and differential expression of variant isoforms. With all this knowledge, it becomes clear that targeting alternative splicing represents an innovative approach for breast cancer therapeutics and the information derived from current studies could guide clinical decisions with a direct impact in the clinical advances for breast cancer patients nowadays.

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“…NET was historically used as an alternative to chemotherapy in older and frail patients with estrogen receptor (ER)-positive breast cancer [1]. However, we have accumulating evidence that NET is an effective and well tolerated alternative to postmenopausal patients with ER-positive/HER2-negative breast cancer, not only to downstage tumors and allow less-extensive surgery, but as a scientific platform to obtain information on tumor resistance and potential biomarkers [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Real-world data on neoadjuvant endocrine therapy in ER-positive/HER2-negative breast cancer

Silva

Andrade

Brenelli

et al. 2021

Breast Cancer Res Treat

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Purpose Neoadjuvant endocrine therapy (NET) has been shown to be effective in ER-positive/HER2-negative breast cancer in clinical trials. However, adoption in clinical practice is still limited. Real-world data may provide useful insights into effectiveness, toxicities and quality of care, potentially rendering clinical trial results to the real-world setting. Our purpose was to report real-world data of a cohort of postmenopausal patients submitted to NET. Methods This prospective cohort study evaluated 146 postmenopausal female patients with ER-positive/HER2-negative breast cancer treated with NET at three tertiary hospitals between 2016 and 2018. Clinicopathological information were collected prospectively. Preoperative Endocrine Prognostic Index (PEPI) score was calculated for tumors submitted to at least 16 weeks of NET. Results Median age was 67 years old, and 87.8% had stage I-II disease. Most tumors had histological grade II (76.1%). Median pretreatment Ki67 expression was 10%. Aromatase inhibitor was used in 99.5% of patients, and median treatment duration was 21.0 weeks. No tumor progressed during NET. Breast-conserving surgery was performed in the majority of patients (63.0%), as well as sentinel lymph-node biopsy (76.7%). Pathological complete response rate was 1.0%. 43 patients (29.5%) had PEPI score 0, and 26% had PEPI scores 4-5. Posttreatment Ki67 median expression was 3.0%, and only five tumors (3.4%) showed marked increase in Ki67 expression during treatment. Seven patients (4.8%) had HER2-positive residual disease, and were treated with adjuvant chemotherapy plus trastuzumab. Conclusions Our real-world data shows that NET is effective and safe in postmenopausal patients with ER-positive/HER2negative breast cancer. Postmenopausal status and low-risk luminal tumor features (luminal A-like) should be used as selection criteria to ensure the best results with NET.

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Multidisciplinary Approach to Neoadjuvant Endocrine Therapy in Breast Cancer: A Comprehensive Review

Cited by 9 publications

References 52 publications

Clinical Implications of ESR1 Mutations in Hormone Receptor-Positive Advanced Breast Cancer

Clinical Implications of ESR1 Mutations in Hormone Receptor-Positive Advanced Breast Cancer

Alternative Splicing in Breast Cancer and the Potential Development of Therapeutic Tools

Real-world data on neoadjuvant endocrine therapy in ER-positive/HER2-negative breast cancer

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