title: Effect of targeted agents on the endocrine response of breast cancer in the neoadjuvant setting: a systematic review.
abstract: Inhibition of aberrantly activated pathways cross-talking with hormone receptor (HR) improves response to endocrine therapy in patients with HR-positive advanced breast cancer. We performed a Pubmed database systematic review to ascertain the existence of a better clinical response when combining endocrine therapy with targeted agents in the neoadjuvant setting. Preclinical studies or trials evaluating toxicity were excluded. We found nine phase II trials that fulfilled the research criteria. The endocrine agents used were third generation aromatase inhibitors (AIs), anastrozole, letrozole or exemestane. The investigated targeted agents were inhibitors of tyrosine kinase receptors such as gefitinib, imatinib or trastuzumab/lapatinib, inhibitors of mTOR, such as everolimus, inhibitors of COX-2, such as celecoxib, and inhibitors of angiogenesis, such as bevacizumab. The response rate (RR) observed combining endocrine and targeted agents ranged between 36% and 90%. Overall the studies failed to show a remarkable advantage in RR in the combination group compared to historical control subjects receiving AIs alone.
authors.affiliation: 1. Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy ; 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Grassadonia
authors.affiliation: 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Caporale
authors.affiliation: 1. Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy ; 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tinari
authors.affiliation: 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Zilli
authors.affiliation: 1. Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy ; 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: DeTursi
authors.affiliation: 3. Department of Oncology, "S.S. Trinita'" Hospital, Sora, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
authors.affiliation: 4. Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation: 1. Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy ; 2. Medical Oncology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Natoli
keywords: breast cancer; clinical response; neoadjuvant endocrine therapy; targeted therapy