Long-Term Outcome of Neoadjuvant Endocrine Therapy with Aromatase Inhibitors in Elderly Women with Hormone Receptor-Positive Breast Cancer

Grassadonia, Antonino; Nicola, Marta Di; Grossi, S.; Noccioli, Paolo; Tavoletta, Saveria; Politi, Roberto; Angelucci, Domenico; Marinelli, Camilla; Zilli, Marinella; Cèfaro, Giampiero Ausili; Tinari, Nicola; Tursi, Michele De; Iezzi, Laura; Cioffi, Pasquale; Iacobelli, Stéfano; Natoli, Clara; Cianchetti, Ettore

doi:10.1245/s10434-014-3535-7

Cited by 13 publications

(14 citation statements)

References 51 publications

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“…A retrospective observational study by Grassadonia showed that clinical response was strongly correlated with BCS and that BCS was an independent prognostic factor for DFS and OS. 12 Our study showed a correlation between clinical response and the type of surgery; the type of surgery was associated with patient prognosis. These results also align with findings of previous reports.…”

Section: Discussionmentioning

confidence: 56%

“…Clinical response to NET is associated with surgical outcome, including conversion from mastectomy to breast-conserving surgery (BCS). 12 However, there are few reports examining the association of clinical response to NET with long-term outcomes. In this report, we examined long-term outcomes of patients who received neoadjuvant exemestane treatment for 24 weeks in a multicentre prospective clinical trial and found that clinical response to NET is an independent predictive marker for long-term survival in postmenopausal patients with endocrine-responsive breast cancer.…”

Section: Introductionmentioning

confidence: 99%

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Impact of clinical response to neoadjuvant endocrine therapy on patient outcomes: a follow-up study of JFMC34-0601 multicentre prospective neoadjuvant endocrine trial

et al. 2018

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BackgroundNeoadjuvant endocrine therapy (NET) has been demonstrated to improve breast-conserving rate and is a widely accepted treatment option for postmenopausal patients with hormone receptor-positive breast cancer. There are few reports on the association of NET response and long-term outcomes.ObjectivesTo investigate the prognostic value of clinical response to NET.MethodsLong-term outcomes of NET were examined in 107 patients who participated in the multicentre prospective neoadjuvant exemestane study, JFMC34-0601. Patients were treated with 25 mg/day exemestane for 16 weeks followed by an 8-week extension depending on the treatment response.ResultsClinical response included partial response (PR) in 58 patients, stable disease in 41 patients and progressive disease (PD) in 8 patients. Clinical response was significantly associated with disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) (P<0.0001 for all). Especially, patients with PD showed markedly poor outcomes with median DFS=17.8 months (HR (vs PR): 7.7 (95% CI 1.6 to 33)) and median OS=37.7 months (HR (vs PR): 26.3 (95% CI 2.4 to 655)). Preoperative endocrine prognostic index (PEPI) were associated with DFS and marginally with OS (P=0.022 and 0.066, respectively). PEPI=0 indicated an excellent prognosis with 95% 5-year DFS (95% CI 73 to 99). In the multivariate analysis including T stage, nodal status and Ki67, clinical response was an independent prognostic factor for DFS, DDFS and OS (P=0.032, 0.0007 and 0.020, respectively), whereas PEPI was marginally associated with DFS and OS (P=0.079 and 0.068, respectively).ConclusionsClinical response to NET showed an independent prognostic value. Patients with PD had markedly poor prognosis, indicating a need of additional therapy. PEPI=0 indicated an excellent prognosis. The integration of clinical response and PEPI would improve decision-making with regard to treatment options for endocrine-responsive breast cancer when these results are validated in a larger clinical trial.Trial registration numberUMIN C000000345.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Impact of clinical response to neoadjuvant endocrine therapy on patient outcomes: a follow-up study of JFMC34-0601 multicentre prospective neoadjuvant endocrine trial

et al. 2018

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“…In terms of ORR, the largest trial (Z1031 trial) did not demonstrate a significant difference between exemestane (62.9%), letrozole (74.8%), and anastrozole (69.1%) (Table 2 ) [ 53 , 54 ]. Other studies comparing aromatase inhibitors also did not demonstrate superiority of any one agent (Table 2 ) [ 28 , 65 , 66 ]. In terms of the BCS rate, there was no significant difference found between the types of aromatase inhibitors or fulvestrant (Table 2 ) [ 28 , 53 , 54 , 65 , 66 ].…”

Section: Resultsmentioning

confidence: 97%

Neoadjuvant endocrine therapy in locally advanced estrogen or progesterone receptor-positive breast cancer: determining the optimal endocrine agent and treatment duration in postmenopausal women—a literature review and proposed guidelines

2020

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Introduction For patients with locally advanced estrogen receptor or progesterone receptor-positive breast cancer, neoadjuvant endocrine therapy (NET) facilitates down-staging of the tumor and increased rates of breast-conserving surgery. However, NET remains under-utilized, and there are very limited clinical guidelines governing which therapeutic agent to use, or the optimal duration of treatment in postmenopausal women. This literature review aims to discuss the evidence surrounding (1) biomarkers for patient selection for NET, (2) the optimal neoadjuvant endocrine agent for postmenopausal women with locally advanced breast cancer, and (3) the optimal duration of NET. In addition, we make initial recommendations towards developing a clinical guideline for the prescribing of NET. Method A wide-ranging search of online electronic databases was conducted using a truncated PIC search strategy to identify articles that were relevant to these aims and revealed a number of key findings. Results Randomized trials have consistently demonstrated that aromatase inhibitors are more effective than tamoxifen, in terms of objective response rate and rate of BCS, and should be used as first-line NET. The three available aromatase inhibitors have so far been demonstrated to be biologically equivalent, with the choice of aromatase inhibitor not having been shown to affect clinical outcomes. There is increasing evidence for extending the duration of NET beyond 3 to 4 months, to at least 6 months or until maximal clinical response is achieved. While on-treatment levels of the proliferation marker Ki67 are predictive of long-term outcome, the choice of adjuvant therapy in patients who have received NET and then surgery is best guided by the preoperative endocrine prognostic index, or PEPI, which incorporates Ki67 with other clinical parameters. Conclusion This study reveals that in appropriately selected patients, NET can provide equivalent clinical benefit to neoadjuvant chemotherapy in the same cohort, if suitable treatments and durations are chosen. Our findings highlight the need for better defined biomarkers both for guiding patient selection and for measuring outcomes. Development of standard guidelines for the prescribing of NET has the potential to improve both clinical outcomes and quality of life in this patient cohort.

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“…Neo-adjuvant chemotherapy reduces tumour size and increases the numbers of patients suitable for surgery, however no difference is seen by age for complete pathological response [ 133 ]. Neo-adjuvant endocrine therapy is of benefit in post-menopausal patients with early breast cancer, improving WLE rates, disease free survival and overall survival [ 134 , 135 ].…”

Section: Age Associated Treatment By Molecular Subtypementioning

confidence: 99%

Effects of Age on the Detection and Management of Breast Cancer

McGuire¹,

Brown²,

Malone³

et al. 2015

Cancers

300

182

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Currently, breast cancer affects approximately 12% of women worldwide. While the incidence of breast cancer rises with age, a younger age at diagnosis is linked to increased mortality. We discuss age related factors affecting breast cancer diagnosis, management and treatment, exploring key concepts and identifying critical areas requiring further research. We examine age as a factor in breast cancer diagnosis and treatment relating it to factors such as genetic status, breast cancer subtype, hormone factors and nodal status. We examine the effects of age as seen through the adoption of population wide breast cancer screening programs. Assessing the incidence rates of each breast cancer subtype, in the context of age, we examine the observed correlations. We explore how age affects patient’s prognosis, exploring the effects of age on stage and subtype incidence. Finally we discuss the future of breast cancer diagnosis and treatment, examining the potential of emerging tests and technologies (such as microRNA) and how novel research findings are being translated into clinically relevant practices.

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Long-Term Outcome of Neoadjuvant Endocrine Therapy with Aromatase Inhibitors in Elderly Women with Hormone Receptor-Positive Breast Cancer

Cited by 13 publications

References 51 publications

Impact of clinical response to neoadjuvant endocrine therapy on patient outcomes: a follow-up study of JFMC34-0601 multicentre prospective neoadjuvant endocrine trial

Impact of clinical response to neoadjuvant endocrine therapy on patient outcomes: a follow-up study of JFMC34-0601 multicentre prospective neoadjuvant endocrine trial

Neoadjuvant endocrine therapy in locally advanced estrogen or progesterone receptor-positive breast cancer: determining the optimal endocrine agent and treatment duration in postmenopausal women—a literature review and proposed guidelines

Effects of Age on the Detection and Management of Breast Cancer

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