title: Multidisciplinary Approach to Neoadjuvant Endocrine Therapy in Breast Cancer: A Comprehensive Review.
abstract: Breast cancer is the most common type of cancer and the leading cause of cancer-related death among women worldwide. Hormone receptor-positive (HR+) tumors represent the most common form of this disease, with more than 70% of breast cancers expressing these receptors. Response and benefit to neoadjuvant chemotherapy (NCT) varies according to HR expression, with lower responses in luminal tumors as compared with hormone receptor-negative (HR-) and human epidermal growth factor receptor 2-positive (HER2+) tumors. Neoadjuvant endocrine therapy (NET) is an option for selected patients with HR+ locally advanced breast cancer. Neoadjuvant endocrine therapy has a favorable toxicity profile, and is associated with benefits such as having low cost and being more easily available even for cancer care professionals outside major urban areas or tertiary centers. These factors are particularly relevant, as 70% of breast cancer deaths occur in women from low-income and middle-income countries. Additionally, NET is being increasingly explored, not simply to allow for less extensive surgery, but also as a scientific tool, with the use of biomarkers to predict outcomes in adjuvant trials and for the individual patient. This review details the current and most relevant evidence about NET for breast cancer as well as the future directions of this field.
authors.affiliation: Department of Medical Oncology, Hospital do Câncer Mãe de Deus, Porto Alegre, RS, Brazil.
authors.forename: Tomás
authors.initials: T
authors.lastname: Reinert
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil.
authors.forename: Susana
authors.initials: S
authors.lastname: Ramalho
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Universidade de São Paulo, SP, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Gonçalves
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Barrios
authors.affiliation: Pathology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Marcia Silveira
authors.initials: MS
authors.lastname: Graudenz
authors.affiliation: Department of Medical Oncology, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Bines
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human