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Meta-analysis Indicates Similar Outcomes With Neoadjuvant Endocrine vs Chemotherapy in Estrogen Receptor–Positive Breast Cancer

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Key Points

  • Neoadjuvant endocrine therapy alone was associated with a similar outcome to that with combination chemotherapy in women with estrogen receptor–positive breast cancer.
  • Outcomes were better with aromatase inhibitors vs tamoxifen.

In a meta-analysis reported in JAMA Oncology, Spring et al found that neoadjuvant endocrine therapy was associated with outcomes similar to those with chemotherapy in women with estrogen receptor–positive breast cancer.

Similar Outcomes

The analysis included 3,490 patients from 20 randomized trials of neoadjuvant therapy containing ≥ 1 endocrine therapy arm. Compared with combination chemotherapy, endocrine therapy alone was associated with a similar clinical response rate (odds ratio [OR] = 1.08, P = .85), radiologic response rate (OR = 1.38, P = .12), and breast-conserving surgery rate (OR = 0.65, P = .07), with endocrine therapy alone being associated with reduced toxicity. Compared with tamoxifen, aromatase inhibitor use was associated with a better clinical response rate (OR = 1.69, P < .001), radiologic response rate (OR = 1.49, P < .001), and breast-conserving surgery rate (OR = 1.62, P < .001). Compared with endocrine therapy alone, dual combination therapy with growth factor pathway inhibitors was associated with a better radiologic response rate (OR = 1.59, P = .03) but not clinical response rate (OR = 0.76, P = .11); the frequency of pathologic complete response was < 10%.

The investigators concluded: “Neoadjuvant endocrine therapy, even as monotherapy, is associated with similar response rates as neoadjuvant combination chemotherapy but with significantly lower toxicity, suggesting that [neoadjuvant endocrine therapy] needs to be reconsidered as a potential option in the appropriate setting. Additional research is needed to develop rational [neoadjuvant endocrine therapy] combinations and predictive biomarkers to personalize the optimal neoadjuvant strategy for ER [-positive] breast cancer.”

The study was supported by a Jerry Younger Grant for Clinical and Translational Breast Cancer Research and grants from the National Cancer Institute.

Aditya Bardia, MD, MPH, of Massachusetts General Hospital Cancer Center, is the corresponding author of the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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