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Abstract
Neoadjuvant chemotherapy has been employed increasingly in operable breast cancer
during recent years. Several randomized trials showed that the chances of breast conserving
therapy are being enhanced, and that survival was not compromised by primary systemic
therapy compared to adjuvant treatment. Apart from the surgical advantages of tumor
downstaging and breast conservation, therapy upfront might offer the chance to predict
subsequent response of an individual patient to a given agent in the adjuvant setting.
Furthermore, by investigating pre- and posttreatment tumor specimens, the neaodjuvant
setting might help to evaluate new predictive biological markers, assess biologic
effects of new treatments, and gain insight into molecular mechanisms. For postmenopausal
patients with receptor-positive disease who cannot tolerate the toxicities of chemotherapy
regimens or are not eligible for immediate surgery, endocrine treatment is emerging
as an attractive alternative in the neoadjuvant setting. The new third-generation
aromatase inhibitors letrozole and anastrozole have been compared to tamoxifen in
3 well-designed randomized neoadjuvant phase III trials (PO24, IMPACT, and PROACT).
These studies showed significantly higher response rates for letrozole than for tamoxifen,
and comparable ones for anastrozole. Thus, the primary use of an aromatase inhibitor
seems a feasible and safe treatment option for postmenopausal women with early-stage
breast cancer who do not wish to or are unable to undergo immediate surgery or preoperative
chemotherapy. Further neoadjuvant endocrine trials should help us to elucidate the
cross-talk between the different signal transduction pathways and their role in endocrine
resistance.
Key words
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Article info
Publication history
Accepted:
April 16,
2004
Received in revised form:
April 15,
2004
Received:
January 30,
2004
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
