Neoadjuvant endocrine therapy for postmenopausal patients with hormone receptor-positive early breast cancer: a new concept

Abstract

Patients with resectable, nonmetastatic (stage I-IIIA) breast cancer usually receive adjuvant (postoperative) systemic therapy to control micrometastasis and prevent recurrence. Neoadjuvant (preoperative) chemotherapy is a standard treatment for resectable breast cancer, potentially enabling patients to undergo partial dissection. However, it has been reported that neoadjuvant chemotherapy has a limited effect in patients with hormone receptor-positive disease in terms of pathologic complete response rate, and in elderly patients there may be safety concerns. Furthermore, the appropriateness of chemotherapy for luminal early breast cancer [defined as hormone receptor-positive and human epidermal growth factor receptor-2 (HER2)-negative tumors] is an important clinical issue. We determine the need for chemotherapy in postmenopausal patients with hormone receptor-positive, HER2-negative, lymph node-negative early breast cancer according to clinicopathologic factors, including multigene signature. The National Surgical Adjuvant Study of Breast Cancer (N-SAS-BC06) New primary Endocrine-therapy Origination Study (NEOS) is a randomized phase III trial conducted in Japanese centers. It is evaluating adjuvant endocrine therapy, with or without chemotherapy, in patients with postmenopausal breast cancer that has responded to neoadjuvant letrozole. The aims of this trial are to: define patients who might not require chemotherapy by using their response to neoadjuvant endocrine therapy; analyze the relationship between neoadjuvant endocrine therapy and long-term prognosis; and analyze the correlation between clinical and pathologic response to neoadjuvant hormonal therapy with additional postoperative chemotherapy. We hope that the results of this trial will lead to the development of a new clinical strategy of pre- and postsurgical treatment for luminal breast cancer.

Efficacy of chemotherapy after hormone therapy for hormone receptor–positive metastatic breast cancer

“…However, considering the findings of the Z1031B trial, clinicians are unlikely to select chemotherapy-effective cases based on the sensitivity to prior HT, even if patients who do not require chemotherapy can be identified. 5 …”

“…However, considering the findings of the Z1031B trial, clinicians are unlikely to select chemotherapy-effective cases based on the sensitivity to prior HT, even if patients who do not require chemotherapy can be identified. 5 Even if HR-positive MBC is not as sensitive to chemotherapy as HR-negative lesions, the administration of chemotherapy for MBC is inevitable. Based on the present results, the use of chemotherapy after HT is effective to a certain extent, regardless of whether HR-positive MBC is sensitive to prior HT.…”

“…Previous studies have investigated the efficacy of chemotherapy for preoperative breast cancer based on the efficacy of precedent neoadjuvant HT. 4 , 5 These trials were conducted based on the hypothesis that chemotherapy can be effective if precedent HT is ineffective or may not be necessary if precedent HT is very effective.…”

Rainbow of KIBOU (ROK) study: a Breast Cancer Survivor Cohort in Japan

“…The eligible subjects for the N-SAS BC05 study are postmenopausal women with hormone-responsive primary breast cancer aged less than 80 years. The eligible subjects for the N-SAS BC06 study are postmenopausal women with primary breast cancer aged less than 75 years [ 6 ]. The eligible subjects for the N-SAS BC07 study are women with HER2-positive primary breast cancer aged between 70 and 80 years [ 7 ].…”

Indications for Interventional Procedures of the Breasts and Axillae

“…Ako izostaje markacija, a lezija više nije jasno uočljiva slikovnim metodama, može se prijeoperacijski markirati područje hematoma ili distorzije ukoliko ono zaostaje nakon biopsije (Slika 1). Međutim, negativni kirurški rubovi prisutni su u svega 31-62 % slučajeva, za razliku od slučajeva kod kojih je postavljen marker, gdje postotak negativnih kirurških rubova raste na 90 % 13,[16][17][18] . Idealnu kiruršku resekciju predstavlja preparat tkiva u čijem je središtu smještena lezija oko koje je rub od maksimalno 1 cm makroskopski zdravog tkiva i čiji su rubovi mikroskopski slobodni od tumorskih stanica (Slika 2).…”