Abstract
Background
Although neoadjuvant chemotherapy (NACT) has been established as a standard for medically
fit patients with locally advanced breast cancer, there has been renewed interest
in utilizing neoadjuvant endocrine therapy (NET) for women with estrogen receptor-positive,
human epidermal growth factor receptor 2-negative breast cancer. Rates of pathologic
complete response (pCR) are known to be low, but data regarding down-staging and long-term
outcomes are inconsistent.
Patients and Methods
A prospective institutional database of patients with breast cancer treated with neoadjuvant
therapy from 2012 to 2017 was analyzed to identify patients with estrogen receptor-positive,
human epidermal growth factor receptor 2-negative breast cancer. Patients who received
NET were compared with those who received NACT. A matched analysis (age, stage, grade)
was performed to compare rates of down-staging, pCR, breast conserving surgery, and
CPS+EG scores.
Results
A total of 176 patients met eligibility criteria. Of these, 111 (63%) patients received
NACT, 51 (29%) received NET, and 14 (8%) received both sequentially. Women prescribed
NET were older (65.5 vs. 51.2 years; P < .0001) and presented with lower clinical stage (P < .0001). The median duration of NET was 90 days. When matched, clinical down-staging
was more frequent with NACT (20/51; 39%) compared with NET (11/51; 22%) (P = .032). Of these, 2% achieved pCR in each cohort. Conversion rates to breast conserving
surgery eligibility were low (8% and 13% with NET and NACT; P = .70). No significant differences in CPS+EG scores were identified.
Conclusions
Significantly higher rates of down-staging were achieved with NACT compared with NET
when patients were matched. This study highlights the importance of establishing tumor
biology and the need for biomarkers that can be used as predictive tools to inform
treatment.
Keywords
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Article info
Publication history
Published online: June 10, 2019
Accepted:
May 27,
2019
Received in revised form:
May 17,
2019
Received:
January 14,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
