title: Neoadjuvant endocrine treatment in early breast cancer: An overlooked alternative?
abstract: During the last decade neoadjuvant endocrine therapy (NET) has moved from being reserved for elderly and frail non-chemotherapy candidates to a primary systemic modality in selected patients with hormone sensitive breast cancer. Neoadjuvant hormonal treatment in patients with hormone receptor positive, HER-2 negative early breast cancer is proven to be an effective and safe option; it is associated with a higher rate of breast conserving surgery (BCS), may reduce the need for adjuvant chemotherapy and enables a delay of surgery for medical or practical reasons. Clinical responses range from 13% to 100% with at least 3 months of NET. Methods of assessing response should include MRI of the breast, particularly in lobular tumours. In studies comparing tamoxifen with aromatase inhibitors (AI), AI proved to be superior in terms of tumour response and rates of BCS. Change in Ki67 is accepted as a validated endpoint for comparing endocrine neoadjuvant agents. Levels of Ki67 during treatment are more closely related to long-term prognosis than pretreatment Ki67. Neoadjuvant endocrine therapy provides a unique opportunity for studies of endocrine responsiveness and the development of new experimental drugs combined with systemic hormonal treatment.
authors.affiliation: Breast Unit of the Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Belgium. Electronic address: peter.vandam@telenet.be.
authors.forename: P A
authors.initials: PA
authors.lastname: van Dam
authors.affiliation: Centre of Oncologic Research (CORE), Antwerp University, Edegem, Belgium.
authors.forename: V C N
authors.initials: VC
authors.lastname: van Dam
authors.affiliation: Breast Unit of the Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Altintas
authors.affiliation: Breast Unit of the Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Papadimitriou
authors.affiliation: Breast Unit of the Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Belgium; Fase 1 Unit for Experimental Oncology, Antwerp University Hospital, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Rolfo
authors.affiliation: Breast Unit of the Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Belgium.
authors.forename: X B
authors.initials: XB
authors.lastname: Trinh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D047072:Aromatase Inhibitors / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000187:drug effects*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Aromatase inhibitors; Breast cancer; Fulvestrant; Neoadjuvant treatment; Oestrogen receptor positive; Tamoxifen