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Neoadjuvant endocrine therapy

Takayuki Ueno, Shigehira Saji, Norikazu Masuda, Katsumasa Kuroi, Nobuaki Sato, Hiroyuki Takei, Yutaka Yamamoto, Shinji Ohno, Hiroko Yamashita, Kazufumi Hisamatsu, Kenjiro Aogi, Hiroji Iwata, Takeharu Yamanaka, Hironobu Sasano, Masakazu Toi
Background: Neoadjuvant endocrine therapy (NET) has been demonstrated to improve breast-conserving rate and is a widely accepted treatment option for postmenopausal patients with hormone receptor-positive breast cancer. There are few reports on the association of NET response and long-term outcomes. Objectives: To investigate the prognostic value of clinical response to NET. Methods: Long-term outcomes of NET were examined in 107 patients who participated in the multicentre prospective neoadjuvant exemestane study, JFMC34-0601...
2018: ESMO Open
Bhavika K Patel, Talal Hilal, Matthew Covington, Nan Zhang, Heidi E Kosiorek, Marc Lobbes, Donald W Northfelt, Barbara A Pockaj
PURPOSE: To evaluate the performance of contrast-enhanced spectral mammography (CESM) compared to MRI in the assessment of tumor response in breast cancer patients undergoing neoadjuvant systemic therapy (NST). METHODS: The institutional review board approved this study. From September 2014 to June 2017, we identified patients with pathologically confirmed invasive breast cancer who underwent NST. All patients had both CESM and MRI performed pre- and post-NST with pathological assessment after surgical management...
March 7, 2018: Annals of Surgical Oncology
Antonella Palazzo, Silvia Dellapasqua, Elisabetta Munzone, Vincenzo Bagnardi, Manuelita Mazza, Giuseppe Cancello, Raffaella Ghisini, Monica Iorfida, Emilia Montagna, Aaron Goldhirsch, Marco Colleoni
BACKGROUND: Inflammatory breast cancer (IBC) is a rare and highly aggressive disease. A neoadjuvant regimen with chemotherapy and an antiangiogenic strategy was investigated. PATIENTS AND METHODS: Patients with primary or recurrent IBC who were candidates for neoadjuvant treatment received weekly carboplatin and paclitaxel plus bevacizumab every 3 weeks and oral metronomic cyclophosphamide for 6 months. Trastuzumab was added for patients with HER2+ tumors and endocrine therapy was added for patients with estrogen receptor and/or progesterone receptor ≥ 10% tumors...
February 2, 2018: Clinical Breast Cancer
Giulia Galli, Giacomo Bregni, Stefano Cavalieri, Luca Porcu, Paolo Baili, Amash Hade, Francesca Di Salvo, Milena Sant, Roberto Agresti, Massimiliano Gennaro, Secondo Folli, Maria C De Santis, Biagio Paolini, Maria L Carcangiu, Filippo de Braud, Serena Di Cosimo
Background: Breast cancer (BC) phenotype after neoadjuvant chemotherapy (NAC) has not been extensively described and few data exist on whether expression of the primary tumor hormone receptors, HER2 and Ki-67 changes as a result of chemotherapy. Materials and Methods: We analyzed specimens from all BC patients treated with anthracycline/taxane-based NAC at our Institution between January 2010 and March 2015 (n = 325). The expression of estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 was determined in pre- and post-NAC specimens...
December 2017: Breast Care
N Masuda, M Toi, N Yamamoto, H Iwata, K Kuroi, H Bando, S Ohtani, T Takano, K Inoue, Y Yanagita, H Kasai, S Morita, T Sakurai, S Ohno
BACKGROUND: Dual blockade of HER2 promises increased pathological complete response (pCR) rate compared with single blockade in the presence of chemotherapy for HER2-positive (+) primary breast cancer. Many questions remain regarding optimal duration of treatment and combination impact of endocrine therapy for luminal HER2 disease. METHODS: We designed a randomised phase II, five-arm study to evaluate the efficacy and safety of lapatinib and trastuzumab (6 weeks) followed by lapatinib and trastuzumab plus weekly paclitaxel (12 weeks) with/without prolongation of anti-HER2 therapy prior to chemotherapy (18 vs...
February 14, 2018: Breast Cancer: the Journal of the Japanese Breast Cancer Society
K Naidoo, S E Pinder
Neoadjuvant therapy is increasingly being recognised as a management option for patients with primary invasive breast carcinoma; this may take the form of primary endocrine treatment or primary chemotherapy. Surgical specimens from women treated with neoadjuvant treatments, particularly primary chemotherapy, may cause a challenge for the histopathologist in handling and interpretation and have, in the past, been sampled, evaluated, and reported in a non-standardised way. This limits comparison between clinical trials and potentially provides clinicians and patients with suboptimal prognostic information...
February 10, 2018: Clinical Radiology
Khairul Majumder, Yvonne Brandberg, Hemming Johansson, Enrique Castellanos, Anders Ullén, Bo Lennernäs, Sten Nilsson
To avoid pubic arch interference, prostate cancer patients are treated with neoadjuvant androgen deprivation therapy (ADT) to achieve prostate volume (PV) reduction prior to radiation treatment. The aim of the present randomised study was to compare the effects on PV of two regimens of ADT, an androgen receptor inhibitor monotherapy vs. castration plus an androgen receptor inhibitor. Consecutive patients with non-metastatic prostate cancer were included in a randomised neoadjuvant study, comparing an androgen receptor inhibitor monotherapy vs...
January 2018: Molecular and Clinical Oncology
Daniele Generali, Silvia Paola Corona, Lajos Pusztai, Roman Rouzier, Giovanni Allevi, Sergio Aguggini, Manuela Milani, Carla Strina, Albane Frati
INTRODUCTION: Neoadjuvant hormonal therapy is generally considered a valid option for hormone receptor positive breast cancer (BC) patients who are unfit for chemotherapy or surgery. AIMS: Whilst numerous studies analyzed efficacy of neoadjuvant chemotherapy (CT) or endocrine therapy (HT) alone in hormone receptor positive patients, there is a lack of research looking at the usefulness of a preoperative combinatorial approach of CT and HT in this patient subgroup...
March 2018: Journal of Cancer Research and Clinical Oncology
Tomás Reinert, Carlos H Barrios
We reviewed randomized phase II/III trials comparing first- or second-line endocrine therapy as monotherapy or in combination with targeted therapies for treatment of postmenopausal patients with hormone receptor-positive advanced breast cancer. First-line was defined as treatment for endocrine therapy-naïve advanced breast cancer or advanced disease treated with endocrine therapy in the adjuvant/neoadjuvant setting. Second-line was defined as endocrine therapy for advanced breast cancer following disease progression on endocrine therapy for advanced disease...
November 2017: Therapeutic Advances in Medical Oncology
Rupert Bartsch, Elisabeth Bergen
At the 2017 ASCO Annual Meeting, several pertinent studies in the field of breast cancer were presented and some are deemed as being potentially practice changing. BrighTNess was the first phase III study to investigate the addition of carboplatin to standard neoadjuvant chemotherapy in triple-negative breast cancer; while toxicity was increased in the experimental group, a significantly higher pathologic complete remission (pCR) rate was observed as well suggesting that adding carboplatin to neoadjuvant anthracycline, cyclophosphamide and taxane-containing regimens is efficacious in otherwise healthy patients...
2017: Memo
Carsten Denkert, Gunter von Minckwitz, Silvia Darb-Esfahani, Bianca Lederer, Barbara I Heppner, Karsten E Weber, Jan Budczies, Jens Huober, Frederick Klauschen, Jenny Furlanetto, Wolfgang D Schmitt, Jens-Uwe Blohmer, Thomas Karn, Berit M Pfitzner, Sherko Kümmel, Knut Engels, Andreas Schneeweiss, Arndt Hartmann, Aurelia Noske, Peter A Fasching, Christian Jackisch, Marion van Mackelenbergh, Peter Sinn, Christian Schem, Claus Hanusch, Michael Untch, Sibylle Loibl
BACKGROUND: Tumour-infiltrating lymphocytes (TILs) are predictive for response to neoadjuvant chemotherapy in triple-negative breast cancer (TNBC) and HER2-positive breast cancer, but their role in luminal breast cancer and the effect of TILs on prognosis in all subtypes is less clear. Here, we assessed the relevance of TILs for chemotherapy response and prognosis in patients with TNBC, HER2-positive breast cancer, and luminal-HER2-negative breast cancer. METHODS: Patients with primary breast cancer who were treated with neoadjuvant combination chemotherapy were included from six randomised trials done by the German Breast Cancer Group...
January 2018: Lancet Oncology
Laura M Arthur, Arran K Turnbull, Lucy R Khan, J Michael Dixon
Purpose of Review: Pre-operative endocrine therapy can be used to down-stage large or locally advanced breast cancers in ER+ disease. In the last four decades, it has evolved from a treatment perceived as an alternative to surgery for those too unfit to undergo surgery or chemotherapy, to the present day where it is a valuable and valid option in the treatment of postmenopausal women with ER-rich (Allred score 7-8, or > 50% staining for ER) breast cancer. Recent Findings: Emerging data from the metastatic setting is translating into neoadjuvant trials, utilising dual endocrine targeting or combinations of endocrine agents and other targeted drugs, including those acting against components of the PI3K pathway and the cell cycle...
2017: Current Breast Cancer Reports
Signe Korsgaard Skriver, Anne-Vibeke Laenkholm, Birgitte Bruun Rasmussen, Jürgen Handler, Bo Grundtmann, Tove Filtenborg Tvedskov, Peer Christiansen, Ann S Knoop, Maj-Britt Jensen, Bent Ejlertsen
INTRODUCTION: Neoadjuvant endocrine treatment (NET) is a low-toxicity approach to achieve operability in locally advanced breast cancer, and to facilitate breast conservation in early breast cancer, particular in patients with highly estrogen receptor (ER) positive and HER2-negative disease. Here, we report the results obtained by neoadjuvant letrozole in patients with early breast cancer in a phase-II design. MATERIAL AND METHODS: A total of 119 postmenopausal women with ER-positive, HER2-negative operable breast cancer were assigned to four months of neoadjuvant letrozole before definitive surgery...
January 2018: Acta Oncologica
Louis Wc Chow, Satoshi Morita, Christopher Yc Chow, Wai Kuen Ng, Masakazu Toi
To test the efficacy of neoadjuvant palbociclib therapy and to evaluate its impact on cell cycle arrest and changes in EndoPredict (EP) scores before and after treatment. Postmenopausal women with histologically proven ER+ve, HER2-ve invasive breast cancer, 2cm or greater, were enrolled in an open-label, single arm study. Twenty eligible patients were given letrozole 2.5mg per day together with palbociclib 125mg per day for 3 out of 4 weeks in repeated cycles for 16 weeks (4 cycles) before surgery. The primary end-points were clinical response rates (cRR) and preoperative endocrine prognostic index (PEPI)...
November 20, 2017: Endocrine-related Cancer
Julie Grossman, Cynthia Ma, Rebecca Aft
Neoadjuvant endocrine therapy (NET) can be effective at downstaging patients with estrogen receptor-positive tumors and identifying those tumors that are endocrine sensitive and resistant. The optimal prognostic markers for stratification are under investigation. Use of NET will allow the identification of patients with estrogen receptor-positive tumors who might benefit from additional treatment and allow better understanding of endocrine resistance.
January 2018: Surgical Oncology Clinics of North America
Mothaffar F Rimawi, Carmine De Angelis, Alejandro Contreras, Fresia Pareja, Felipe C Geyer, Kathleen A Burke, Sabrina Herrera, Tao Wang, Ingrid A Mayer, Andres Forero, Rita Nanda, Matthew P Goetz, Jenny C Chang, Ian E Krop, Antonio C Wolff, Anne C Pavlick, Suzanne A W Fuqua, Carolina Gutierrez, Susan G Hilsenbeck, Marilyn M Li, Britta Weigelt, Jorge S Reis-Filho, C Kent Osborne, Rachel Schiff
PURPOSE: Aberrant activation of the PI3K pathway has been implicated in resistance to HER2-targeted therapy, but results of clinical trials are confounded by the co-administration of chemotherapy. We investigated the effect of perturbations of this pathway in breast cancers from patients treated with neoadjuvant anti-HER2-targeted therapy without chemotherapy. PATIENTS AND METHODS: Baseline tumor samples from patients with HER2-positive breast cancer enrolled in TBCRC006 (NCT00548184), a 12-week neoadjuvant clinical trial with lapatinib plus trastuzumab [plus endocrine therapy for estrogen receptor (ER)-positive tumors], were assessed for PTEN status by immunohistochemistry and PIK3CA mutations by sequencing...
November 7, 2017: Breast Cancer Research and Treatment
B Robinson, B Dijkstra, V Davey, S Tomlinson, C Frampton
AIMS: To assess adherence to adjuvant endocrine therapy by a real-world cohort of women in Christchurch and to determine any associated factors. MATERIALS AND METHODS: Records were retrieved of all women newly diagnosed with early breast cancer and registered on the Christchurch Breast Cancer Patient Register over 4 years from June 2009. Demographic and pathological factors, dates of starting and stopping endocrine therapies and reported side-effects were collected...
January 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
Veronika Guenther, Ibrahim Alkatout, Wiebe Junkers, Dirk Bauerschlag, Nicolai Maass, Soeren von Otte
Many premenopausal patients who develop breast cancer have not yet completed their family planning, so measures of fertility protection to preserve their fertile potential would be beneficial. Polychemotherapy causes irreversible damage to the ovarian follicles - irrespective of whether in a neoadjuvant or adjuvant setting - and this can sometimes result in permanent infertility. Depending on which cytostatic agents are used and on the age-related ovarian reserve of the woman, gonadotoxic risk must be classified as low, moderate or high...
October 2017: Geburtshilfe und Frauenheilkunde
Wei Wu, Heran Deng, Nanyan Rao, Na You, Yaping Yang, Minghui Cao, Jieqiong Liu
BACKGROUND: The response to neoadjuvant chemotherapy (NAC) varies by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) statuses, with responses being lower in ER-positive, HER2-negative tumors as compared with ER-negative, HER2-positive or triple-negative tumors. Neoadjuvant endocrine therapy (NET) is an attractive alternative to NAC for ER-positive, HER2-negative cancer. However, a prior trial comparing NET with standard NAC in ER-positive tumor showed that the difference of response was not significant...
October 25, 2017: Trials
Haisong Yang, Ling Li, Mengmeng Zhang, Shiyong Zhang, Shu Xu, Xiaoxia Ma
RATIONALE: Although rare, occult breast cancer (OBC) originates from breast tissue. Its primary lesions cannot be identified by clinical examination or imaging; therefore, the diagnosis, treatment, and prognosis remain controversial. PATIENT CONCERNS: This study comprised 5 female OBC patients who were admitted to the Affiliated Hospital of Guizhou Medical University for painless axillary lumps. DIAGNOSES: F-flurodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) indicated metastasis in the ipsilateral axillary lymph nodes...
October 2017: Medicine (Baltimore)
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