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Neoadjuvant endocrine therapy

Pat Whitworth, Peter Beitsch, Angela Mislowsky, James V Pellicane, Charles Nash, Mary Murray, Laura A Lee, Carrie L Dul, Michael Rotkis, Paul Baron, Lisette Stork-Sloots, Femke A de Snoo, Jennifer Beatty
PURPOSE: Hormone receptor-positive (HR+) tumors have heterogeneous biology and present a challenge for determining optimal treatment. In the Neoadjuvant Breast Registry Symphony Trial (NBRST) patients were classified according to MammaPrint/BluePrint subtyping to provide insight into the response to neoadjuvant endocrine therapy (NET) or neoadjuvant chemotherapy (NCT). OBJECTIVE: The purpose of this predefined substudy was to compare MammaPrint/BluePrint with conventional 'clinical' immunohistochemistry/fluorescence in situ hybridization (IHC/FISH) subtyping in 'clinical luminal' [HR+/human epidermal growth factor receptor 2-negative (HER2-)] breast cancer patients to predict treatment sensitivity...
October 21, 2016: Annals of Surgical Oncology
Monika Brzezinska, Linda J Williams, Jeremy Thomas, J Michael Dixon
PURPOSE: Inflammatory breast cancer (IBC) is rare and associated with a poor prognosis. Following neoadjuvant chemotherapy or endocrine therapy, the multidisciplinary team selected a small number of patients for breast-conservation therapy (BCT). The aim of this study was to determine the outcome of IBC patients treated with BCT in Edinburgh. METHODS: Between January 1999 and December 2013, thirty-five women with IBC were treated by BCT. The median follow-up was 80 months...
October 18, 2016: Breast Cancer Research and Treatment
Brittany L Bychkovsky, Don S Dizon, William M Sikov
Breast cancer is a heterogenous disease, comprised of at least 3 major subtypes: hormone receptor-positive/HER2-(HR+), HER2+, and HR-/HER2-(triple negative) breast cancers. The medical management of each subype is distinct. In this article, we review contemporary data supporting the use of chemotherapy, endocrine therapy and biologic therapies, especially HER2-directed agents, in the adjuvant and neoadjuvant setting in patients with newly diagnosed nonmetastatic (stage I-III) breast cancer.
October 12, 2016: Clinical Obstetrics and Gynecology
Sun Young Chae, Sung-Bae Kim, Sei Hyun Ahn, Hye Ok Kim, Dok Hyun Yoon, Jin-Hee Ahn, Kyung Hae Jung, Sangwon Han, Seung Jun Oh, Sang Ju Lee, Hee Jeong Kim, Byung Ho Son, Gyungyub Gong, Hyo Sang Lee, Dae Hyuk Moon
: The aim of this study was to explore the ability of (18)F-fluoroestradiol ((18)F-FES) positron emission tomography/computed tomography (PET/CT) imaging to predict pathologic response to neoadjuvant therapy in postmenopausal women with estrogen receptor (ER)-rich breast cancer. METHODS: This was a prospective, single-center study conducted as a sub-study of the neoadjuvant study of chemotherapy versus endocrine therapy in postmenopausal patients with primary breast cancer (NEOCENT) trial...
September 29, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Akiko Chiba, Tanya L Hoskin, Courtney N Heins, Kelly K Hunt, Elizabeth B Habermann, Judy C Boughey
BACKGROUND: The American College of Surgeons Oncology Group Z1031 trial demonstrated that neoadjuvant endocrine therapy (NET) increased breast-conserving surgery (BCS) rates for postmenopausal patients with clinical tumor stage 2-4c estrogen receptor-positive breast cancer. We evaluated national trends in NET use in relation to the conduct of the Z1031 trial and the impact of NET on the rates of BCS. METHODS: Using the National Cancer Data Base (NCDB), we identified all cT2-4c hormone receptor (HR)-positive breast cancer patients age ≥50 years from 2004 to 2012...
September 23, 2016: Annals of Surgical Oncology
Akiko Ogiya, Kieko Yamazaki, Rie Horii, Tadahiko Shien, Yoshiya Horimoto, Norikazu Masuda, Touko Inao, Mitsuchika Hosoda, Naoko Ishida, Tomofumi Osako, Masato Takahashi, Yumi Endo, Yuichiro Miyoshi, Hiroyuki Yasojima, Nobumoto Tomioka, Hiroko Yamashita
BACKGROUND: Few studies have been performed on post-relapse survival in patients with the early and late distant recurrence in estrogen receptor (ER)-positive, HER2-negative breast cancer. METHODS: A total of 205 patients with the early distant recurrence and 134 patients with the late distant recurrence of ER-positive, HER2-negative breast cancer who had undergone breast surgery or neoadjuvant chemotherapy between January 2000 and December 2004 were registered from nine institutions...
September 15, 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Lei Lei, Xiaojia Wang, Zhanhong Chen
Monitoring recurrence and evaluating response to therapy are important aspects of clinical decision making in the treatment of breast cancer. In this literature review, the authors highlight several of the key areas where integrated fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) measurements are anticipated to have a significant impact on monitoring recurrence and evaluating response to therapy. These areas include comparing FDG PET/CT with conventional imaging for detecting breast cancer metastases; evaluating the role of FDG PET/CT in the presence of elevated tumor markers during follow-up period after the primary surgery; using FDG PET/CT to assess response to neoadjuvant chemotherapy (NAC), targeted and endocrine therapies; using FDG PET/CT to predict response to NAC according to different molecular phenotypes of breast cancer; and applying PET/CT and some new breast-related PET tracers to evaluate response to anticancer treatment...
March 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Kimihiro Tanaka, Eriko Tokunaga, Nami Yamashita, Yasuaki Sagara, Yasuyo Ohi, Kenichi Taguchi, Shinji Ohno, Shinji Okano, Yoshinao Oda, Yoshihiko Maehara
BACKGROUND: Estrogen receptor (ER)/GATA3/Forkhead box A1 (FOXA1) network is necessary for the ERα functional signature. High FOXA1 expression indicates a good prognosis in ER-positive breast cancer. However, little is known about the significance of FOXA1 and GATA3 expression in neoadjuvant endocrine therapy (NAE). The aim of this study is to investigate their predictive potential for NAE and their expression changes after NAE. METHODS: FOXA1 and GATA3 expression was evaluated using immunohistochemistry in 66 patients with ER-positive/HER2-negative breast cancer who had been treated with NAE...
July 29, 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Laura M Spring, Arjun Gupta, Kerry L Reynolds, Michele A Gadd, Leif W Ellisen, Steven J Isakoff, Beverly Moy, Aditya Bardia
Importance: Estrogen receptor-positive (ER+) tumors of the breast are generally highly responsive to endocrine treatment. Although endocrine therapy is the mainstay of adjuvant treatment for ER+ breast cancer, the role of endocrine therapy in the neoadjuvant setting is unclear. Objective: To evaluate the effect of neoadjuvant endocrine therapy (NET) on the response rate and the rate of breast conservation surgery (BCS) for ER+ breast cancer. Data Sources: Based on PRISMA guidelines, a librarian-led search of PubMed and Ovid MEDLINE was performed to identify eligible trials published from inception to May 15, 2015...
June 30, 2016: JAMA Oncology
Florence Lerebours, Sofia Rivera, Marie-Ange Mouret-Reynier, Severine Alran, Laurence Venat-Bouvet, Pierre Kerbrat, Remy Salmon, Veronique Becette, Céline Bourgier, Pascal Cherel, Véronique Boussion, Corinne Balleyguier, Fabienne Thibault, Sandrine Lavau-Denes, Jean-Marc Nabholz, Brigitte Sigal, Martine Trassard, Marie-Christine Mathieu, Anne-Laure Martin, Jerome Lemonnier, Emmanuelle Mouret-Fourme
BACKGROUND: Treatment strategies for locally advanced breast cancer in elderly patients too frail to receive neoadjuvant chemotherapy and the introduction of new classes of drugs in the early 2000s have led to the consideration of endocrine therapy as a neoadjuvant treatment for younger hormone receptor (HR)-positive, postmenopausal patients not eligible for primary breast-conserving surgery (BCS). METHODS: This was a multicenter, phase 2, randomized trial designed to evaluate as its primary objective the clinical response rate after up to 6 months of neoadjuvant endocrine therapy (NET) alone in HR-positive/human epidermal growth factor receptor 2 (HER2)-negative patients with 1 mg of anastrozole (arm A) or 500 mg of fulvestrant (arm B)...
October 2016: Cancer
Adriana Priscila Trapé, Shuying Liu, Andrea Carolina Cortes, Naoto T Ueno, Ana Maria Gonzalez-Angulo
Among patients with hormone receptor (HR)-positive breast cancer, those with residual disease after neoadjuvant chemotherapy have a higher risk of relapse and poorer survival than those with a complete response. Previous studies have revealed a correlation between activation of cell cycle-regulating pathways in HR-positive breast cancer, particularly cyclin-dependent kinase (CDK) 4 and 6/cyclin D1 signaling, and resistance to standard therapies. Although CDK4/6 inhibition by palbociclib in combination with endocrine therapy has shown potent antiproliferative effects in HR-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer, the potential role of palbociclib in re-sensitizing chemotherapy-resistant HR-positive breast cancer is not well defined...
2016: Journal of Cancer
Maria J Fernández-Cabezudo, Issam Faour, Kenneth Jones, Devin P Champagne, Mohammed A Jaloudi, Yassir A Mohamed, Ghada Bashir, Saeeda Almarzooqi, Alia Albawardi, M Jawad Hashim, Thomas S Roberts, Haytham El-Salhat, Hakam El-Taji, Adnan Kassis, Dylan E O'Sullivan, Brock C Christensen, James DeGregori, Basel K Al-Ramadi, Mercedes Rincon
Despite major advances in early detection and prognosis, chemotherapy resistance is a major hurdle in the battle against breast cancer. Identifying predictive markers and understanding the mechanisms are key steps to overcoming chemoresistance. Methylation-controlled J protein (MCJ, also known as DNAJC15) is a negative regulator of mitochondrial respiration and has been associated with chemotherapeutic drug sensitivity in cancer cell lines. Here we show, in a retrospective study of a large cohort of breast cancer patients, that low MCJ expression in breast tumors predicts high risk of relapse in patients treated with chemotherapy; however, MCJ expression does not correlate with response to endocrine therapy...
May 19, 2016: JCI Insight
Josee-Lyne Ethier, Eitan Amir
Several multi-gene assays have been developed to predict the risk of recurrence in patients with estrogen receptor-positive early breast cancer and in whom endocrine therapy is planned. The 21-gene assay is widely used and its prognostic value has been retrospectively validated, showing significant differences in the risk of distant recurrence for patients at high versus low risk. Its role in predicting chemotherapy benefit has also been established, showing a clear benefit for high-risk patients and minimal benefit in those at low risk...
August 2016: Molecular Diagnosis & Therapy
William Gradishar, Kilian E Salerno
The updates to management of early invasive breast cancer in 2016 are minor but have important treatment implications for patients. The NCCN Guidelines Panel for Breast Cancer has added endocrine therapy to its recommendations for the neoadjuvant treatment of patients with ER-rich tumors. For women who are premenopausal at diagnosis, the NCCN Guidelines suggest tamoxifen for 5 years, with or without ovarian suppression, or an aromatase inhibitor for 5 years combined with ovarian suppression or ablation. For HER2-positive patients, neoadjuvant pertuzumab is acceptable, and in advanced estrogen receptor-positive disease, palbociclib can be given with endocrine therapy...
May 2016: Journal of the National Comprehensive Cancer Network: JNCCN
L I Smith, S Dayal, J Murray, A Lannigan
BACKGROUND: The majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making. METHODS: A questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013...
2016: SpringerPlus
Hyun-Ah Kim, Sei Hyun Ahn, Seok Jin Nam, Seho Park, Jungsil Ro, Seock-Ah Im, Yong Sik Jung, Jung Han Yoon, Min Hee Hur, Yoon Ji Choi, Soo-Jung Lee, Joon Jeong, Se-Heon Cho, Sung Yong Kim, Min Hyuk Lee, Lee Su Kim, Byung-In Moon, Tae Hyun Kim, Chanheun Park, Sei Joong Kim, Sung Hoo Jung, Heungkyu Park, Geum Hee Gwak, Sun Hee Kang, Jong Gin Kim, Jeryong Kim, Su Yun Choi, Cheol-Wan Lim, Doyil Kim, Youngbum Yoo, Young-Jin Song, Yoon-Jung Kang, Sang Seol Jung, Hyuk Jai Shin, Kwan Ju Lee, Se-Hwan Han, Eun Sook Lee, Wonshik Han, Hee-Jung Kim, Woo Chul Noh
BACKGROUND: Ovarian function suppression (OFS) has been shown to be effective as adjuvant endocrine therapy in premenopausal women with hormone receptor-positive breast cancer. However, it is currently unclear if addition of OFS to standard tamoxifen therapy after completion of adjuvant chemotherapy results in a survival benefit. In 2008, the Korean Breast Cancer Society Study Group initiated the ASTRRA randomized phase III trial to evaluate the efficacy of OFS in addition to standard tamoxifen treatment in hormone receptor-positive breast cancer patients who remain or regain premenopausal status after chemotherapy...
2016: BMC Cancer
Wei Wang, Chenghao Liu, Wenbin Zhou, Tiansong Xia, Hui Xie, Shui Wang
In clinical practice, it is necessary to define an optimal choice from many different therapeutic regimens. This study aimed to assess the efficacy and safety of neoadjuvant endocrine therapy (NET) for breast cancer patients. Randomized clinical trials were included. Nine studies comprising 2133 patients were included in the final analysis. Network meta-analysis showed that everolimus plus letrozole was more easily accepted by patients than exemestane (≥20wks) (odds ratio (OR): 856697.02, 95% confidence intervals (95%CI): 1...
2016: Scientific Reports
Jun-Jie Li, Zhi-Min Shao
Hormone receptor (HR) positive breast cancers represent the vast majority of breast cancers. Adjuvant and/or neoadjuvant endocrine therapy is highly effective and appropriate for nearly all women with HR positive tumors. Adjuvant tamoxifen (TAM) is a major endocrine treatment option, which has been found to be effective in both premenopausal and postmenopausal patients. Considerable evidence has been accrued of a benefit for ovarian ablation or suppression (OA/S) in premenopausal patients, for aromatase inhibitors (AIS) in postmenopausal patients, for the longer duration of adjuvant endocrine therapy and for the clinical utility of neoadjuvant endocrine therapy...
June 2016: Chinese Clinical Oncology
Debra E Lyon, Ronald Cohen, Huaihou Chen, Debra L Kelly, Angela Starkweather, Hyo-Chol Ahn, Colleen K Jackson-Cook
PURPOSE: Cognitive dysfunction in women with breast cancer continues to be an area of intense research interest. The prevalence, severity, timing, and cognitive domains that are most affected, as well as the contribution of cancer and its treatments to cognition, remain unresolved. Thus, longitudinal studies are needed that examine cognitive function during different stages of breast cancer treatment and survivorship. This longitudinal trial followed women with early-stage breast cancer, prior to chemotherapy through 2 years survivorship...
July 2016: Journal of Cancer Research and Clinical Oncology
Renu Gahlaut, Aneliese Bennett, Hiba Fatayer, Barbara J Dall, Nisha Sharma, Galina Velikova, Tim Perren, David Dodwell, Mark Lansdown, Abeer M Shaaban
PURPOSE: To assess the effect of neoadjuvant chemotherapy (NACT) on breast cancer characteristics, hormone receptors and human epidermal growth factor receptor 2 (HER2) expression and whether testing should be repeated on residual tumours. MATERIAL AND METHODS: Patients with primary operable breast cancer who received NACT at a single United Kingdom tertiary referral centre were included. Tumour type, grade (including details of mitotic grade, tubule formation and pleomorphism), oestrogen receptor (ER), progesterone receptor (PR) and HER2 status were compared between pre-treatment and post-treatment residual samples using tissue microarrays...
June 2016: European Journal of Cancer
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