Utilization, duration, and outcomes of neoadjuvant endocrine therapy in the United States

Pariser, Ashley; Sedghi, Tannaz; Soulos, Pamela R.; Killelea, Brigid K.; Gross, Cary P.; Mougalian, Sarah Schellhorn

doi:10.1007/s10549-019-05397-4

Cited by 17 publications

(14 citation statements)

References 28 publications

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“…In spite of this, NAC remains a therapeutic strategy of choice for patients with locally advanced (IIb-IIIc) disease, in those requiring pre-operative downstaging, and in women hoping for breast conservation despite an increased tumour to breast ratio [45]. In conventional ER þ breast cancer management, NET is typically prescribed in 3.1% of cases, compared to NAC in 24.7% of cases [46]. In their meta-analysis of prospective trials, Spring et al describe similar pCR rates for patients with ER þ disease receiving NET vs. those prescribed NAC, however, suffer significantly less toxicities [47].…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of the 21-gene assay in predicting response to neoadjuvant endocrine therapy in breast cancer: A systematic review and meta-analysis

et al. 2021

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Introduction: OncotypeDX© Recurrence Score (RS) is a multigene panel used to aid therapeutic decision making in early-stage, estrogen receptor positive (ERþ)/human epidermal growth factor receptor-2 negative (HER2-) breast cancer. Aim: To compare responses to neoadjuvant endocrine therapy (NET) in patients with ERþ/HER2-breast cancer following substratification by RS testing. Methods: This systematic review was performed in accordance to the PRISMA guidelines. Studies evaluating pathological complete response (pCR), partial response (PR), and successful conversion to breast conservation surgery (BCS) rates following NET guided by RS were retrieved. Dichotomous outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs) following estimation by Mantel-Haenszel method. Results: Eight prospective studies involving 691 patients were included. The mean age was 62.6 years (range 25e85) and the mean RS was 14.5 (range 0e68). Patients with RS < 25 (OR: 4.60, 95% CI: 2.53 e8.37, P < 0.001) and RS < 30 (OR: 3.40, 95% CI: 1.96e5.91, P < 0.001) were more likely to achieve PR than their counterparts. NET prescription failed to increase BCS conversion rates for patients with RS < 18 (OR: 0.23, 95% CI: 0.04e1.47, P ¼ 0.120) and RS > 30 (OR: 1.27, 95% CI: 0.64e2.49, P ¼ 0.490) respectively. Only 22 patients achieved pCR (2.8%) and RS group failed to predict pCR following NET (P ¼ 0.850). Conclusion:Estimations from this analysis indicate that those with low-intermediate RS on core biopsy are four times more likely to respond to NET than those with high-risk RS. Performing RS testing on diagnostic biopsy may be useful in guiding NET prescription.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of the 21-gene assay in predicting response to neoadjuvant endocrine therapy in breast cancer: A systematic review and meta-analysis

et al. 2021

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“…Similarly, a study of neoadjuvant exemestane showed a 7.7% progression rate at 4 months, increasing to only 8% at 6 months of treatment [21]. Despite the evidence, uptake of NET remained suboptimal, and it was stated that neoadjuvant ET in postmenopausal women with ER+ stage 2/3 tumors is currently underused, although it shows low toxicity when compared to neoadjuvant chemotherapy (panel discussion at the 2017 St. Gallen Conference) [22]. NET for up to 12 months is safe with close monitoring of tumor burden.…”

Section: Current Status Of Systemic Neoadjuvant Therapymentioning

confidence: 99%

Targeted Neoadjuvant Therapies in HR+/HER2−Breast Cancers: Challenges for Improving pCR

Dey

Aske

2021

Cancers

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A strong association of pCR (pathological complete response) with disease-free survival or overall survival is clinically desirable. The association of pCR with disease-free survival or overall survival in ER+/HER2−breast cancers following neoadjuvant systemic therapy (NAT) or neoadjuvant endocrine therapy (NET) is relatively low as compared to the other two subtypes of breast cancers, namely triple-negative and HER2+ amplified. On the bright side, a neoadjuvant model offers a potential opportunity to explore the efficacy of novel therapies and the associated genomic alterations, thus providing a rare personalized insight into the tumor’s biology and the tumor cells’ response to the drug. Several decades of research have taught us that the disease’s biology is a critical factor determining the tumor cells’ response to any therapy and hence the final outcome of the disease. Here we propose two scenarios wherein apoptosis can be induced in ER+/HER2− breast cancers expressing wild type TP53 and RB genes following combinations of BCL2 inhibitor, MDM2 inhibitor, and cell-cycle inhibitor. The suggested combinations are contextual and based on the current understanding of the cell signaling in the ER+/HER2− breast cancers. The two combinations of drugs are (1) BCL2 inhibitor plus a cell-cycle inhibitor, which can prime the tumor cells for apoptosis, and (2) BCL2 inhibitor plus an MDM2 inhibitor.

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“…In the United States of America, real-world data showed that women with breast cancer who received NET for longer treatment durations had increased odds of BCS and downstaging than women who did not receive NET. 23 NET helps to avoid surgery without tumor progression; this is even more important during the ongoing coronavirus disease pandemic. 24 Hayashi et al examined the time to progression in patients with stage II or III breast cancer treated with NET in a previous multicenter study; the median time to progression was approximately 3 years.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Endocrine Therapy for Operable Breast Cancer: A Retrospective Analysis of Real-World Use

et al. 2021

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Background: A retrospective study of the real-world use of neoadjuvant endocrine therapy (NET) is important for standardizing its role in breast cancer care. Materials and Methods: In a consecutive series of women with operable breast cancer who received NET for ≥28 days, NET objectives, NET outcomes, adjuvant chemotherapy use after NET, and survivals, were examined for the correlation with clinicopathological factors. Results: NET objectives were for surgery extent reduction in 49 patients, surgery avoidance in 31, and treatment until scheduled surgery in 8. The mean duration of NET was 349.5 (range, 34-1923), 869.8 (range, 36-4859), and 55.8 (range, 39-113) days in the above cohorts (success: 79.6%, 64.5%, and 100%), respectively, with significant difference. In patients of the former two cohorts, better progression-free survival was significantly correlated with stage 0 or I, ductal carcinoma in situ or invasive ductal carcinoma, ≥71% estrogen receptor (ER) positivity, and the surgery extent reduction cohort than the other counterparts. Postoperative chemotherapy use was significantly correlated with lymph node metastasis, a high Ki67 labeling index, lymphovascular invasion, and a high Preoperative Endocrine Prognostic Index, at surgery after NET. Better recurrence-free survival after surgery was significantly correlated with high ER expression after NET and high PgR expression before and after NET. Conclusions: NET can help to reduce the surgery extent or to avoid surgery in women with breast cancer of early-stage, ductal carcinoma, or high ER expression. NET may also contribute to appropriate decision of postoperative systemic therapy to improve survivals.

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Utilization, duration, and outcomes of neoadjuvant endocrine therapy in the United States

Cited by 17 publications

References 28 publications

Clinical utility of the 21-gene assay in predicting response to neoadjuvant endocrine therapy in breast cancer: A systematic review and meta-analysis

Clinical utility of the 21-gene assay in predicting response to neoadjuvant endocrine therapy in breast cancer: A systematic review and meta-analysis

Targeted Neoadjuvant Therapies in HR+/HER2−Breast Cancers: Challenges for Improving pCR

Neoadjuvant Endocrine Therapy for Operable Breast Cancer: A Retrospective Analysis of Real-World Use

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