Optimizing the Use of Neoadjuvant Endocrine Therapy

Agrawal, Laila S.; Mayer, Ingrid A.

doi:10.1007/s11912-015-0455-z

Cited by 2 publications

(2 citation statements)

References 57 publications

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“…The main purpose of NET is to downstage tumors potentially turning inoperable cases into operable ones, and allowing breast conservation surgery (BCS) for previously ineligible patients. Furthermore, response to NET can be evaluated in vivo, which can theoretically be a surrogate marker of tumor biology and effectiveness of adjuvant endocrine therapy . Response to NET is almost always partial and complete pathologic responses are seldom seen.…”

Section: Introductionmentioning

confidence: 99%

Breast MRI phenotype and background parenchymal enhancement may predict tumor response to neoadjuvant endocrine therapy

et al. 2018

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Neoadjuvant endocrine therapy (NET) is increasingly used for the treatment of estrogen receptor positive, HER2 negative breast cancer. We evaluated whether MRI phenotype and background parenchymal enhancement (BPE) can predict response to NET. Patients with localized breast cancer treated with NET and had a pre-treatment breast MRI were identified. Baseline MRI phenotype and BPE was interpreted by a single radiologist blinded to the results of systemic therapy. Response was defined as stable disease or reduction in tumor size on clinical and/or ultrasound examination. Of the 21 patients identified, 17 were responders; all patients with minimal/mild BPE had a response compared to 5/9 (56%) patients with moderate/marked BPE (P = 0.02). All four nonresponders had moderate/marked BPE as compared to 5/17 (29%) responders (P = 0.02). This pilot study suggests that minimal/mild BPE may be predictive of a positive response to NET. A higher degree of background enhancement was significantly predictive of negative response to NET.

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Section: Introductionmentioning

confidence: 99%

Breast MRI phenotype and background parenchymal enhancement may predict tumor response to neoadjuvant endocrine therapy

et al. 2018

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“…Similar treatment outcomes, including clinical response and breast conservation surgery rates, are observed for both neoadjuvant ET and chemotherapy (5, 6), and recent analysis in the adjuvant setting suggests that ET alone is just as effective as ET plus chemotherapy in patients with low/intermediate risk HR+ breast cancer (7). As such, given the more favorable side-effect profile of ET compared with chemotherapy (5, 6), neoadjuvant ET has become a clinically acceptable strategy for pre- and postmenopausal patients with HR+ early-stage and locally advanced breast cancer (8, 9). The combination of targeted therapy and ET in metastatic HR+ breast cancer has improved clinical outcomes such as progression-free survival (10, 11); however, the question of whether combining targeted agents with ET can further improve treatment outcomes in the neoadjuvant setting is still under investigation.…”

Section: Introductionmentioning

confidence: 99%

A Phase II Randomized Study of Neoadjuvant Letrozole Plus Alpelisib for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer (NEO-ORB)

Mayer

Prat

Egle

et al. 2019

Clinical Cancer Research

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Purpose: Addition of alpelisib to fulvestrant significantly extended progression-free survival in PIK3CA-mutant, hormone receptor-positive (HR+) advanced/metastatic breast cancer in the phase III SOLAR-1 study. The combination of alpelisib and letrozole also had promising activity in phase I studies of HR+ advanced/metastatic breast cancer. NEO-ORB aimed to determine if addition of alpelisib to letrozole could increase response rates in the neoadjuvant setting. Experimental Design: Postmenopausal women with HR+, human epidermal growth factor receptor 2-negative, T1c-T3 breast cancer were assigned to the PIK3CA-wild-type or PIK3CA-mutant cohort according to their tumor PIK3CA status, and randomized (1:1) to 2.5 mg/day letrozole with 300 mg/day alpelisib or placebo for 24 weeks. Primary endpoints were objective response rate (ORR) and pathologic complete response (pCR) rate for both PIK3CA cohorts. Results: In total, 257 patients were assigned to letrozole plus alpelisib (131 patients) or placebo (126 patients). Grade ≥3 adverse events (≥5% patients) in the alpelisib arm were hyperglycemia (27%), rash (12%), and maculo-papular rash (8%). The primary objective was not met; ORR in the alpelisib vs. placebo arm was 43% vs. 45% and 63% vs. 61% in the PIK3CA-mutant and -wild-type cohorts, respectively. pCR rates were low in all groups. Decreases in Ki-67 were similar across treatment arms and cohorts. In PIK3CA-mutant tumors, alpelisib plus letrozole treatment induced a greater decrease in phosphorylated AKT vs. placebo plus letrozole. Conclusions: In contrast to initial results in advanced/metastatic disease, addition of alpelisib to 24-week neoadjuvant letrozole treatment did not improve response in patients with HR+ early breast cancer.

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Optimizing the Use of Neoadjuvant Endocrine Therapy

Cited by 2 publications

References 57 publications

Breast MRI phenotype and background parenchymal enhancement may predict tumor response to neoadjuvant endocrine therapy

Breast MRI phenotype and background parenchymal enhancement may predict tumor response to neoadjuvant endocrine therapy

A Phase II Randomized Study of Neoadjuvant Letrozole Plus Alpelisib for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer (NEO-ORB)

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