neoadjuvant endocrine therapy a reasonable option "for ER positive breast cancer -
By Shreeya Nanda
endocrine therapy should be reconsidered as a potential option in neoadjuvant for localized estrogen receptor (ER) -positive of breast cancer, say the authors of a meta-analysis.
The analysis, published in JAMA Oncology , included 340 patients from 20 randomized trials that had at least one arm of assessing neoadjuvant endocrine therapy and reported response rates.
researchers found that in the neoadjuvant setting, endocrine monotherapy with aromatase inhibitors (AI) was comparable to combination chemotherapy compared to the rates of clinical and radiological response, pathologic complete response (pCR ) and following breast-conserving surgery (BCS). But the toxicity was significantly lower with endocrine therapy than chemotherapy.
In addition, endocrine therapy with AIs compared with tamoxifen resulted in significantly improved response rate and clinical and radiological BCS, with odds ratios (OR) 1.69, 1, 49 and 1.62, respectively. The PCRS rates did not differ significantly between women who received the AIs and those given tamoxifen, but investigators emphasize that "the total number of events was small and only 3 studies reported pCR."
they also emphasize that "conclusions about the enhanced rate of BCS are limited because generally determine eligibility for BCS is inherently subjective and depends on several variables, including patient preference. "
Comparison of neoadjuvant endocrine therapy given either as monotherapy or in combination with another agent such as everolimus, celecoxib or lapatinib, showed that clinical response rates were similar, but the rate of X-ray response was significantly better with dual therapy (OR = 1.49)
results were similar when monotherapy endocrine system was compared to a combination therapy incorporating pathway inhibitor of growth factor. - the clinical response rate was not improved with dual therapy, but the radiological response rate was significantly higher (OR = 1.59)
lead author Aditya Bardia (Massachusetts General Hospital Cancer . Center, Boston, USA) and co-researchers therefore conclude: "neoadjuvant endocrine therapy is a reasonable treatment option for localized [ER-positive] breast cancer, and further studies are needed to develop rational combinations endocrine therapy and predictive biomarkers to optimize [neoadjuvant endocrine therapy] strategies. "
medwireNews licensed by permission of Springer Healthcare Ltd. © Springer Healthcare Ltd. All rights reserved. None of these parties endorse or recommend any commercial products, services or equipment.
EmoticonEmoticon