Neoadjuvant Endocrine Therapy in Clinical Practice

Sella, Tal; Weiss, Anna; Mittendorf, Elizabeth A.; King, Tari A.; Pilewskie, Melissa; Giuliano, Armando E.; Metzger‐Filho, Otto

doi:10.1001/jamaoncol.2021.2132

Cited by 28 publications

(42 citation statements)

References 78 publications

(137 reference statements)

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“…The solution for the ILC cohort, which have a strong tendency towards hormone positivity, may be a more widespread use of Neoadjuvant Endocrine Therapy (NET); in their review, Sella et al. reported that NET prescription is underutilised despite its capabilities of achieving tumour downstaging in select cases, indicating that NET may have a more conventional use in prospective HR + breast cancer management [ 83 , 84 ]. Similarly, Davey et al.…”

Section: Discussionmentioning

confidence: 99%

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

et al. 2022

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Meta-analysis of >87,000 patients demonstrates that patients with invasive lobular carcinoma of the breast are far less likely to achieve pCR of the breast or axilla compared to their ductal counterparts, receive less BCS and more frequently return positive margins. Background Neoadjuvant chemotherapy (NACT) facilitates tumour downstaging, increases breast conserving surgery (BCS) and assesses tumour chemosensitivity. Despite clinicopathological differences in Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC), decision making surrounding the use NACT does not take account of histological differences. Aim To determine the impact NACT on pathological complete response (pCR), breast conserving surgery (BCS), margin status and axillary pCR in ILC and IDC. Methods A systematic review was performed in accordance with the PRISMA guidelines. Studies reporting outcomes among ILC and IDCs following NACT were identified. Dichotomous variables were pooled as odds ratios (ORs) with 95% confidence intervals_(CI) using the Mantel-Haenszel method. P- values <0.05 were statistically significant. Results 40 studies including 87,303 (7596 ILC [8.7%]and 79,708 IDC [91.3%]) patients were available for analysis. Mean age at diagnosis was 54.9 vs. 50.9 years for ILC and IDC, respectively. IDCs were significantly more likely to achieve pCR (22.1% v 7.4%, OR: 3.03 [95% CI 2.5–3.68] p < 0.00001), axillary pCR (23.6% vs. 13.4%, OR: 2.01 [95% CI 1.77–2.28] p < 0.00001) and receive BCS (45.7% vs. 33.3%, OR 2.14 [95% CI 1.87–2.45] p < 0.00001) versus ILCs. ILCs were significantly more likely to have positive margins at the time of surgery (36% vs 13.5%, OR 4.84 [95% CI 2.88–8.15] p < 0.00001). Conclusion This is the largest study comparing the impact of NACT among ILC and IDC with respect to pCR and BCS. ILC has different outcomes to IDC following NACT and incorporate it into treatment decisions and future clinical guidelines.

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Section: Discussionmentioning

confidence: 99%

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

et al. 2022

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“…The downstaging phenomenon is established in oncology research. An example is the remarkable effect of neoadjuvant therapy, which describes a situation in which the effect of treatment allows for the definition of the stage of the disease as less advanced [ 82 , 83 , 84 ]. Similarly, in heart failure, where New York Heart Association (NYHA) functional class is a commonly used staging method, novel treatment such as sacubitril/valsartan can cause a reduction in the NYHA class [ 85 , 86 ].…”

Section: Discussionmentioning

confidence: 99%

The Downstaging Concept in Treatment-Resistant Depression: Spotlight on Ketamine

Wilkowska

Cubała

2022

IJMS

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Treatment-resistant depression is a pleomorphic phenomenon occurring in 30% of patients with depression. The chance to achieve remission decreases with every subsequent episode. It constitutes a significant part of the global disease burden, causes increased morbidity and mortality, and is associated with poor quality of life. It involves multiple difficult-to-treat episodes, with increasing resistance over time. The concept of staging captures the process of changes causing increasing treatment resistance and global worsening of functioning in all areas of life. Ketamine is a novel rapid-acting antidepressant with neuroplastic potential. Here, we argue that ketamine use as an add-on treatment of resistant major depressive disorder, based on its unique pharmacological properties, can reverse this process, give hope to patients, and prevent therapeutic nihilism.

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“…This is an urgent clinical need because long-term resistance to endocrine therapy is a common event (Burstein 2020). Neoadjuvant endocrine therapy (NET) results in pathological and clinical response rates similar to those observed with neoadjuvant chemotherapy (NCT), although with lower toxicity (Spring et al 2016;Sella et al 2021). Three pioneer clinical trials (IMPACT, PROACT and P024) demonstrated that NET is effective in downsizing ER+ BC and facilitating breast-conserving surgery (BCS), also showing a greater efficacy for aromatase inhibitors compared with tamoxifen (Eiermann et al 2001;Cataliotti et al 2006; I. E. Smith et al 2005).…”

Section: Introductionmentioning

confidence: 99%

A prospective study on tumour response assessment methods after neoadjuvant endocrine therapy in early oestrogen receptor positive breast cancer

López-Velazco

Manzano

Otaño

et al. 2023

Preprint

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Neoadjuvant endocrine therapy in oestrogen receptor (ER) positive HER2 negative breast cancer allows real-time evaluation of drug efficacy as well as investigation of the biological and molecular changes that occur after estrogenic deprivation. Clinical and pathological evaluation after neoadjuvant endocrine therapy may be used to obtain prognostic and predictive information of tumour response to decide adjuvant treatment. In this setting, clinical scales developed to evaluate response after neoadjuvant chemotherapy are not useful and there are not many validated biomarkers to assess response to neoadjuvant endocrine therapy beyond Ki67 expression and preoperative prognostic index (PEPI) score. In this prospective study, we extensively analysed radiological (by ultrasound and magnetic resonance imaging) and pathological tumour response of 104 postmenopausal patients with ER+/HER2- resectable breast cancer, treated with neoadjuvant endocrine treatment for a mean of 7 months prior to surgery. Our results show that radiological evaluation by both USS and MRI underestimate pathological tumour size, although they support the use of MRI over USS to clinically assess tumour response. In addition, we propose that the tumour cellularity size, calculated as the product of the percentage of residual tumour cellularity in the surgical specimen and the tumour pathological size, could become a new tool to standardize response assessment to NET given its good correlation with and potential added value to existing biomarkers. Our findings shed light on the dynamics of tumour response to neoadjuvant endocrine therapy, challenge the paradigm of the ability of NET to decrease surgical volume and point to the utility of the tumour cellularity size to quantify the scattered tumour response usually produced by endocrine therapy.

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Neoadjuvant Endocrine Therapy in Clinical Practice

Cited by 28 publications

References 78 publications

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

The Downstaging Concept in Treatment-Resistant Depression: Spotlight on Ketamine

A prospective study on tumour response assessment methods after neoadjuvant endocrine therapy in early oestrogen receptor positive breast cancer

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