Neoadjuvant endocrine therapy in postmenopausal women with HR+/HER2- breast cancer

Martínez-Pérez, Carlos; Turnbull, Arran; Kay, Charlene; Dixon, J. Michael

doi:10.1080/14737140.2023.2162043

Cited by 2 publications

(6 citation statements)

References 188 publications

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“…The studies have shown that pCR is less useful and also inaccurate as a marker of treatment response in NET and HR+ BC. 49 In this study, although most of the patients (44/56) were in the RCB class II, a very low rate of local recurrence (2/56) and metastasis (1/56) were detected during follow‐up. pCR rates are low for ER+ tumours receiving NET therapy, but it is indicated that this rate can be increased with longer treatment time.…”

Section: Discussionmentioning

confidence: 53%

“…The unfavourable impact of higher RCB scores on RFS and OS are not consistent on HR (+)/HER‐2 negative BC and luminal BC is shown less pCR. The studies have shown that pCR is less useful and also inaccurate as a marker of treatment response in NET and HR+ BC 49 . In this study, although most of the patients (44/56) were in the RCB class II, a very low rate of local recurrence (2/56) and metastasis (1/56) were detected during follow‐up.…”

Section: Discussionmentioning

confidence: 55%

“… 45 , 46 , 47 However, RCB is not effective in confirming long‐term prognosis for patients with HR+ cancer neither after NAC, nor after NET. 47 , 48 , 49 , 50 The unfavourable impact of higher RCB scores on RFS and OS are not consistent on HR (+)/HER‐2 negative BC and luminal BC is shown less pCR. The studies have shown that pCR is less useful and also inaccurate as a marker of treatment response in NET and HR+ BC.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research demonstrated that the prognostic impact of RCB on OS and recurrence‐free survival (RFS) are mainly driven by RCB class after NAC and a high RCB group has been related with a bad prognosis 45–47 . However, RCB is not effective in confirming long‐term prognosis for patients with HR+ cancer neither after NAC, nor after NET 47–50 . The unfavourable impact of higher RCB scores on RFS and OS are not consistent on HR (+)/HER‐2 negative BC and luminal BC is shown less pCR.…”

Section: Discussionmentioning

confidence: 99%

“…Because the response to endocrine therapy is slow, NET duration has ranged from 3 to 6 months in most clinical studies. There are studies showing that a longer NET duration can lead to better NET response rates 49 . Llombart‐Cussac et al showed a median time to maximum response with letrozole of 4.2 months 52 .…”

Section: Discussionmentioning

confidence: 99%

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The immune microenvironment characterisation and dynamics in hormone receptor–positive breast cancer before and after neoadjuvant endocrine therapy

et al. 2023

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BackgroundOestrogen receptor positive (ER+)/HER‐2 negative breast cancer (BC) is considered to be an immunologically cold tumour compared to triple negative breast cancer. Therefore, the tumour microenvironment (TME) of ER+/HER‐2 negative BC is understudied. The aim of this project is to investigate the TME and the immune response during neoadjuvant endocrine therapy (NET) and to correlate this with the treatment response in a real life setting.MethodsExpression of immune checkpoint receptors and immune cells was examined immunohistochemically, pre‐ and post‐NET in a cohort of 56 ER+/HER‐2 negative BC patients. They were treated with tamoxifen (n = 16), an aromatase inhibitor (n = 40) or a combination of an aromatase inhibitor with a PI3K inhibitor (n = 11) for a median duration of 6 months (range 1–32 months). Immunohistochemical staining with monoclonal antibodies for PDL‐1, PD‐1, TIM‐3, LAG‐3, CTLA‐4, CD4, CD68 and FOXP3 were performed. All staining procedures were done according to validated protocols, and scoring was done by a pathologist specialized in breast cancer. Positivity was defined as staining >1% on TILs. Response to NET was evaluated according to tumour size change on imaging and Ki‐67 change.ResultsThe median age was 61.02 (37–90) years. Diameter of tumour size decreased with a mean of 8.1 mm (−16 mm to 45 mm) (p < 0.001) during NET and the value of Ki‐67 value decreased with a median of 9 after NET (p < 0.001). An increase in PD‐L1 expression after NET showed a trend towards significant (p = 0.088) and CD‐4+ T cells significantly increased after NET (p = 0.03). A good response to NET defined as a decrease in tumour size and/or decrease of Ki‐67 was found to be associated with a longer duration of NET, a change of CD4+ T‐cells and a higher number of CD68+ tumour‐associated macrophages before the start of NET.ConclusionThe immune microenvironment plays an important role in ER+/HER‐2 negative BC. NET influences the composition and functional state of the infiltrating immune cells. Furthermore, changes in the immune microenvironment are also associated with treatment response.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The immune microenvironment characterisation and dynamics in hormone receptor–positive breast cancer before and after neoadjuvant endocrine therapy

et al. 2023

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Management of the axilla in postmenopausal patients with cN0 hormone receptor-positive/HER2-negative breast cancer treated with neoadjuvant endocrine therapy and its prognostic impact

García‐Tejedor

Falo

Fernández-González

et al. 2023

Breast Cancer Res Treat

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To evaluate the differences when performing the sentinel lymph node biopsy (SLNB) before or after neoadjuvant endocrine therapy (NET) in breast cancer patients, and the impact of its timing on prognosis. MethodsA retrospective cohort study including 91 postmenopausal cases with clinically node-negative and hormone receptor-positive/HER2 negative (HR+/HER2-) breast cancer, treated with NET and SLNB at our institution. SLNB was performed pre-NET until 2014, and post-NET thereafter. Axillary lymph node dissection (ALND) was indicated only in SLNB-macrometastasis, although in selected elderly patients it was omitted. Kaplan-Meier survival curves were obtained in relation to the status of the axilla, and the differences assessed using the log-rank test. ResultsBetween December 2006 and March 2022, SLNB was performed pre-NET in 14 cases and post-NET in 77. SLNB-positivity was similar regardless of whether SLNB was performed before or after NET (35.7% and 37%, respectively), with 2/14 SLN macrometastases in the pre-NET cohort and 17/77 in the post-NET cohort. Only three patients (18.7%) with SLN macrometastasis had > 3 positive nodes following axillary node dissection. The 5-year overall survival and distant disease-free survival were 92.4% and 94.8% respectively, with no signi cant differences according to SLNB status. ConclusionSLN positivity did not differ according to its timing (before or after NET). Therefore, NET has no effect on lymph node clearance. Furthermore, the prognosis is good regardless of the axillary involvement. Therefore, factors other than axillary involvement may affect the prognosis in these patients.

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Neoadjuvant endocrine therapy in postmenopausal women with HR+/HER2- breast cancer

Cited by 2 publications

References 188 publications

The immune microenvironment characterisation and dynamics in hormone receptor–positive breast cancer before and after neoadjuvant endocrine therapy

The immune microenvironment characterisation and dynamics in hormone receptor–positive breast cancer before and after neoadjuvant endocrine therapy

Management of the axilla in postmenopausal patients with cN0 hormone receptor-positive/HER2-negative breast cancer treated with neoadjuvant endocrine therapy and its prognostic impact

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