Neoadjuvant tamoxifen for hormone-sensitive non-metastatic breast carcinomas in early postmenopausal women

Mauriac, L.; Debled, Marc; Durand, M.; Floquet, Anne; Boulanger, Vincent; Dagada, Corinne; Trufflandier, Nathalie; MacGrogan, Gaëtan

doi:10.1093/annonc/mdf037

Cited by 33 publications

(20 citation statements)

References 19 publications

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“…49,51 Neoadjuvant endocrine therapy also has a role in the treatment of breast cancer, particularly in postmenopausal women with hormone-responsive disease who are unable to tolerate toxicities associated with chemotherapy or who may be ineligible for immediate surgery. 1,17 In these patients, neoadjuvant therapy offers the promise of improving survival or enabling subsequent breast-conserving surgery. As in advanced breast cancer, the third-generation aromatase inhibitors have proven to be better tolerated than tamoxifen, with efficacy comparable to or superior to neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…After a median follow-up of 83 months, median time with metastasis-free survival was 88 months, and overall survival was 102 months in women with T4 tumors. 17 Three randomized controlled studies have evaluated the role of primary endocrine treatment in comparison with initial radiotherapy or surgery. 15,18,19 None of these studies showed a difference for overall survival between the different treatments, although a nonsignificant delay in metastatic events when tamoxifen was given as induction treatment was reported in 1 study.…”

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confidence: 99%

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Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

Семиглазов

Semiglazov

Dashyan

et al. 2007

Cancer

281

153

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BACKGROUND.Few studies have compared primary neoadjuvant endocrine therapy with neoadjuvant chemotherapy in breast cancer patients. The need for preoperative chemotherapy with doxorubicin or taxanes may be reduced in postmenopausal patients with estrogen receptor (ER)‐positive and/or progesterone receptor (PgR)‐positive tumors. This randomized, controlled, phase 2 study evaluated the efficacy of neoadjuvant chemotherapy compared with endocrine treatment with aromatase inhibitors in postmenopausal women with ER‐positive and/or PgR‐positive breast cancer.METHODS.Eligible patients were randomly assigned to receive neoadjuvant anastrozole 1 mg/day (n = 61) or exemestane 25 mg/day (n = 60) for 3 months or doxorubicin 60 mg/m2 with paclitaxel 200 mg/m2 (four 3‐week cycles). Study end points included overall objective response determined by palpation, mammography, and ultrasound, and the number of patients who qualified for breast‐conserving surgery and radiotherapy.RESULTS.Clinical objective response was 64% in the endocrine therapy and chemotherapy treatment groups. Median time to clinical response was 57 and 51 days with aromatase inhibitors and chemotherapy, respectively (P > .05). Rates of pathological complete response (3% vs 6%) and disease progression (9% vs 9%) did not differ significantly in the endocrine therapy or chemotherapy group, respectively (P > .05). Rates of breast‐conserving surgery were slightly higher in the endocrine group (33% vs 24%; P = .058). The most frequent toxicities from chemotherapy were alopecia (79%), grade 3/4 neutropenia (33%), and grade 2 neuropathy (30%). Endocrine treatment was well tolerated. No deaths occurred during the preoperative treatment.CONCLUSIONS.Preoperative neoadjuvant endocrine therapy with aromatase inhibitors was well tolerated and resulted in rates similar to chemotherapy in overall objective response and breast‐conserving surgery in postmenopausal women with ER‐positive and/or PgR‐positive tumors. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

Семиглазов

Semiglazov

Dashyan

et al. 2007

Cancer

281

153

View full text Add to dashboard Cite

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“…A pCR was achieved in 42% of patients with ER-negative tumors, versus 12% of ERpositive patients [7,8]. In a different study by Gianni et al [50], 89 patients were treated with neoadjuvant AT for three cycles, followed by 12 weekly cycles of paclitaxel. ER-negative tumors again had a higher pCR rate than ERpositive tumors (23% vs. 8%, respectively) [50].…”

Section: Preoperative Hormonal Therapymentioning

confidence: 99%

“…In a different study by Gianni et al [50], 89 patients were treated with neoadjuvant AT for three cycles, followed by 12 weekly cycles of paclitaxel. ER-negative tumors again had a higher pCR rate than ERpositive tumors (23% vs. 8%, respectively) [50]. In the NSABP B-27 trial, pCR rates after AC × 4 were 14% in ER-negative and 6% in ER-positive tumors, and 23% and 14%, respectively, after AC × 4 → D × 4 [18,19].…”

Section: Preoperative Hormonal Therapymentioning

confidence: 99%

Primary Systemic Therapy of Breast Cancer

et al. 2006

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Primary systemic therapy (PST) or neoadjuvant therapy is used in nonmetastatic breast cancer to treat systemic disease earlier, decrease tumor bulk ideally to a complete pathological response (pCR), and reduce the extent of surgery. The multitude of clinical trials using PST in breast cancer patients has not proven the fundamental hypotheses of improved overall survival and disease-free survival that drove the investigation of PST. The other potential advantages of PST, which include increasing the rate of breast-conserving surgery and predicting outcome to a particular chemotherapy regimen, are also not conclusively established. We examined the published literature on PST for breast cancer and predominantly focused our review on data from large, randomized clinical trials comparing primary systemic chemotherapy with adjuvant chemotherapy, different primary systemic chemotherapy regimens, primary systemic chemotherapy with hormonal therapy, and different preoperative hormonal therapies. Although the optimal neoadjuvant chemotherapy regimen has not been established, a combination of four cycles of an anthracycline followed by four cycles of a taxane appears to produce the highest pCR rate (22%-31%). In patients with HER-2-positive breast cancer, concurrent use of neoadjuvant trastuzumab with an anthracycline-taxane combination has produced provocative results that require further confirmatory studies. Preoperative hormonal therapy is associated with low pCR rates and should be reserved for patients who are poor candidates for systemic chemotherapy. The optimal management of patients with residual disease after the administration of maximum neoadjuvant therapy remains to be defined. The surgical approach, including the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients, is evolving. Ongoing clinical trials will help identify the subset of patients who would most benefit from the use of PST, establish the most effective PST regimen, and determine the optimal multidisciplinary approach in the management of breast cancer. The Oncologist 2006;11:574-589 Learning ObjectivesAfter completing this course, the reader will be able to:1. Describe the rationale for using primary systemic therapy (PST) in the treatment of nonmetastatic breast cancer.2. Discuss the pathologic complete response (pCR) rate as a surrogate marker of PST benefit.3. Select the most appropriate regimen for a patient with breast cancer considered for PST.4. Explain the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients.Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S.

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“…L'analyse de la littérature montre des chiffres de conservation mammaire après chimiothérapie néoadjuvante proche de 50% [9,10]. Cependant, cette chimiothérapie première n'apporte pas de bénéfice de survie par rapport à une chimiothérapie postopératoire [9,10].…”

Section: Matériels Et Méthodes:-unclassified

Conservative Treatment of Breast Cancer, Experience of the General Surgery Department of the Avicenne Military Hospital.

Lahkim¹,

Ramraoui²,

FassiFihri³

et al. 2017

IJAR

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Neoadjuvant tamoxifen for hormone-sensitive non-metastatic breast carcinomas in early postmenopausal women

Abstract: A comparison between neoadjuvant endocrine therapy and surgery seems feasible to assess the concept of neoadjuvant hormonotherapy.

Cited by 33 publications

References 19 publications

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

Primary Systemic Therapy of Breast Cancer

Conservative Treatment of Breast Cancer, Experience of the General Surgery Department of the Avicenne Military Hospital.

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