Neoadjuvant Endocrine Therapy in Breast Cancer Management: State of the Art

Lerebours, Florence; Cabel, Luc; Pierga, Jean‐Yves

doi:10.3390/cancers13040902

Cited by 12 publications

(7 citation statements)

References 92 publications

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“…In addition, the clinical evaluation of response to NET is often subjective (and is especially difficult in invasive lobular carcinoma), pCR to NET is rare, and the value of residual cancer burden index after NET has not yet been established. 45 Our study therefore requires confirmation in a larger series of patients receiving a more uniform course of NET.…”

Section: Discussionmentioning

confidence: 85%

“…In addition, for some patients, the goal of NET was not to downstage but rather to defer surgery because of COVID-19 pandemic, hence length of NET was variable and not tied to response, and clinical and imaging assessments during therapy were limited because of the COVID-19 pandemic. In addition, the clinical evaluation of response to NET is often subjective (and is especially difficult in invasive lobular carcinoma), pCR to NET is rare, and the value of residual cancer burden index after NET has not yet been established 45. Our study therefore requires confirmation in a larger series of patients receiving a more uniform course of NET.…”

Section: Discussionmentioning

confidence: 94%

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EZH2 Protein Expression in Estrogen Receptor Positive Invasive Breast Cancer Treated With Neoadjuvant Endocrine Therapy: An Exploratory Study of Association With Tumor Response

Gan

Makower

et al. 2022

Applied Immunohistochemistry &Amp; Molecular Morphology

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Introduction: Neoadjuvant endocrine therapy (NET) can be used to treat estrogen receptor positive (ER+) invasive breast cancer (IBC). Tumors with Ki67>10% after 2 to 4 weeks of NET are considered resistant to endocrine therapy. Enhancer of Zeste Homolog 2 (EZH2) is a targetable oncoprotein and overexpression in ER+ IBC has been linked to resistance to endocrine therapy. We examined whether EZH2 expression levels in ER+ IBC could be used to predict response to NET. Materials and Methods: We retrospectively identified 46 patients with localized ER+ HER2/neu negative IBC treated with a minimum of 4 weeks of NET. We quantified EZH2 nuclear expression in pretherapy core biopsies using a score that included intensity and percent of cells staining. Ki67 was evaluated in both pretherapy core biopsies and posttherapy tumor resections and scored according to the guidelines of the International Ki67 Working Groups, with a global weighted score. Ki67≤10% after NET was considered endocrine responsive. Logistic regression analysis was performed to determine the association between EZH2 expression and response to NET. Results: We found significant associations of tumor grade (P=0.011), pretherapy Ki67 (P=0.003), and EZH2 (P<0.001), with response to NET. On logistic regression adjusted for tumor grade and pretherapy Ki67, increased EZH2 scores were associated with decreased odds of endocrine responsiveness, defined as posttreatment Ki67≤10% (odds ratio=0.976, 95% CI, 0.956 to 0.997; P=0.026). In addition, with EZH2 score in the model, associations of tumor grade and pretreatment Ki67 with posttreatment Ki67≤10% response to NET became not significant. Conclusions: Our results suggest that EZH2 might be a useful biomarker to predict response to NET.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 94%

EZH2 Protein Expression in Estrogen Receptor Positive Invasive Breast Cancer Treated With Neoadjuvant Endocrine Therapy: An Exploratory Study of Association With Tumor Response

Gan

Makower

et al. 2022

Applied Immunohistochemistry &Amp; Molecular Morphology

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“…Endocrine therapy is the main treatment method for hormone receptor positive (ER positive and/or PR positive) BC patients. And this treatment can be used as a neoadjuvant therapy or adjuvant therapy for patients with Luminal A or Luminal B subtype of BC (Zelnak and O'Regan, 2015;Lerebours et al, 2021). The goal of endocrine therapy is to block the function of estrogen or lower the level of estrogen which could stimulate the growth of BC cells.…”

Section: Endocrine Therapymentioning

confidence: 99%

The potential role of nanomedicine in the treatment of breast cancer to overcome the obstacles of current therapies

Yang

Dai

et al. 2023

Front. Pharmacol.

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Breast cancer (BC) is the most frequently diagnosed malignant tumor among women in the world. BC is the heterogeneous tumor with different subtypes including luminal A-like, luminal B-like (HER2-/HER2+), HER2 enriched, and triple-negative BC. The therapeutic strategies including surgery, chemotherapy, radiotherapy, targeted therapy, and endocrine therapy are well developed and commonly used in the treatment of BC. However, some adverse effects of these conventional treatments limited their wide application in clinical. Therefore, it is necessary to develop more safe and more efficient individualized treatment strategies of the BC. Nanomedicine, as the most promising strategy for controlled and targeted drug delivery, is widely used in multiple aspects of cancer therapy. Importantly, accumulative evidences show that nanomedicine has achieved good outcomes in the treatment of BC and a huge amount of BC patients benefited from the nanomedicine related treatments. In this review, we summarized and discussed the major problems occurred during the administration of conventional treatment strategies for BC and the potential roles of nanomedicine in promoting the treatment efficacy of BC by overcoming obstacles of current treatment of BC.

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“…Neoadjuvant endocrine therapy (NeoET) trials for patients with clinical stage II-III breast cancer that is hormone receptor-positive and HER2-negative (HR þ /HER2 À ) provide an opportunity to evaluate the impact of a relatively short preoperative exposure to endocrine therapy on the cellular and/or pathologic response in the primary tumor, yet retain the ability to offer chemotherapy later if deemed appropriate (1)(2)(3). However, a means is needed to identify which patients presenting with clinical stage II-III HR þ /HER2 À disease are most appropriate to begin NeoET.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Sensitivity to Endocrine Therapy Index (SET2,3) for Response to Neoadjuvant Endocrine Therapy and Longer-Term Breast Cancer Patient Outcomes (Alliance Z1031)

Suman

Hoskin

et al. 2022

Clinical Cancer Research

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Purpose: To evaluate prediction of response and event-free survival (EFS) following neoadjuvant endocrine therapy by SET2,3 index of nonproliferation gene expression related to estrogen and progesterone receptors adjusted for baseline prognosis. Experimental Design: A correlative study was conducted of SET2,3 measured from gene expression profiles of diagnostic tumor (Agilent microarrays) in 379 women with cStage II–III breast cancer from the American College of Surgeons Oncology Group Z1031 neoadjuvant aromatase inhibitor trial SET2,3 was dichotomized using the previously published cutoff. Fisher exact test was used to assess the association between SET2,3 and low proliferation at week 2–4 [Ki67 ≤ 10% or complete cell-cycle arrest (CCCA; Ki67 ≤ 2.7%)] and PEPI-0 rate in cohort B, and the association between SET2,3 and ypStage 0/I in all patients. Cox models were used to assess EFS with respect to SET2,3 excluding cohort B patients who switched to chemotherapy. Results: Patients with high SET2,3 had higher rate of pharmacodynamic response than patients with low SET2,3 (Ki67 ≤ 10% in 88.2% vs. 56.9%, P < 0.0001; CCCA in 50.0% vs. 26.2%, P = 0.0054), but rate of ypStage 0/I (24.0% vs. 20.4%, P = 0.4580) or PEPI = 0 (28.4% vs. 20.6%, P = 0.3419) was not different. Patients with high SET2,3 had longer EFS than patients with low SET2,3 (HR, 0.52, 95% confidence interval: 0.34–0.80; P = 0.0026). Conclusions: This exploratory analysis of Z1031 data demonstrated a higher rate of pharmacodynamic suppression of proliferation and longer EFS in high SET2,3 disease relative to low SET2,3 disease. The ypStage 0/I rate and PEPI = 0 rate were similar with respect to SET2,3.

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Neoadjuvant Endocrine Therapy in Breast Cancer Management: State of the Art

Cited by 12 publications

References 92 publications

EZH2 Protein Expression in Estrogen Receptor Positive Invasive Breast Cancer Treated With Neoadjuvant Endocrine Therapy: An Exploratory Study of Association With Tumor Response

EZH2 Protein Expression in Estrogen Receptor Positive Invasive Breast Cancer Treated With Neoadjuvant Endocrine Therapy: An Exploratory Study of Association With Tumor Response

The potential role of nanomedicine in the treatment of breast cancer to overcome the obstacles of current therapies

Evaluation of Sensitivity to Endocrine Therapy Index (SET2,3) for Response to Neoadjuvant Endocrine Therapy and Longer-Term Breast Cancer Patient Outcomes (Alliance Z1031)

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