Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG)

TY - JOUR

T1 - Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG)

AU - Skriver, Signe Korsgaard

AU - Lænkholm, Anne-Vibeke

AU - Rasmussen, Birgitte Bruun

AU - Handler, Jürgen

AU - Grundtmann, Bo

AU - Tvedskov, Tove Filtenborg

AU - Christiansen, Peer

AU - Knoop, Ann S

AU - Jensen, Maj-Britt

AU - Ejlertsen, Bent

N1 - Volume 57, 2018 - Issue 1: Papers at the occasion of the 40-years anniversary of DBCG – the Danish Breast Cancer Cooperative Group and the 16th Acta Oncologica Symposium, Aarhus, Denmark - January 18-19, 2018

PY - 2018/1/2

Y1 - 2018/1/2

N2 - 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. Sentinel node or diagnostic fine needle aspiration cytology procedure was performed prior to treatment and the women were assessed prior, at two months, and before surgery with clinical examination, mammography and ultrasonography. Surgical specimens were examined for pathological response. Primary outcome was pathological and clinical response.RESULTS: The per protocol population consisted of 112 patients. Clinical response was evaluated in 109 patients and pathological response in 108. Overall a mean decrease in tumor size was 15% (p ≤ .0001). One patient had complete pathological response and 55% of patients had partial pathological response. ER at 100%, ductal subtype, tumor size below 2 cm and lymph node-negative status was significantly associated with a better response to NET and malignancy grade 3 with a poorer response to NET. One patient progressed during treatment and received neoadjuvant chemotherapy. Eight patients received adjuvant chemotherapy due to lack of response.CONCLUSION: Neoadjuvant aromatase inhibitor therapy is an acceptable strategy in selected postmenopausal patients with ER-rich and HER2-negative early breast cancer with ductal histology and should be considered when chemotherapy either isn't indicated or feasible.

AB - 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. Sentinel node or diagnostic fine needle aspiration cytology procedure was performed prior to treatment and the women were assessed prior, at two months, and before surgery with clinical examination, mammography and ultrasonography. Surgical specimens were examined for pathological response. Primary outcome was pathological and clinical response.RESULTS: The per protocol population consisted of 112 patients. Clinical response was evaluated in 109 patients and pathological response in 108. Overall a mean decrease in tumor size was 15% (p ≤ .0001). One patient had complete pathological response and 55% of patients had partial pathological response. ER at 100%, ductal subtype, tumor size below 2 cm and lymph node-negative status was significantly associated with a better response to NET and malignancy grade 3 with a poorer response to NET. One patient progressed during treatment and received neoadjuvant chemotherapy. Eight patients received adjuvant chemotherapy due to lack of response.CONCLUSION: Neoadjuvant aromatase inhibitor therapy is an acceptable strategy in selected postmenopausal patients with ER-rich and HER2-negative early breast cancer with ductal histology and should be considered when chemotherapy either isn't indicated or feasible.

KW - Aged

KW - Aged, 80 and over

KW - Aromatase Inhibitors/therapeutic use

KW - Breast Neoplasms/metabolism

KW - Carcinoma, Ductal, Breast/metabolism

KW - Denmark

KW - Female

KW - Humans

KW - Letrozole

KW - Lymph Node Excision

KW - Mastectomy

KW - Mastectomy, Segmental

KW - Middle Aged

KW - Neoadjuvant Therapy

KW - Nitriles/therapeutic use

KW - Postmenopause

KW - Receptors, Estrogen/metabolism

KW - Triazoles/therapeutic use

U2 - 10.1080/0284186x.2017.1401228

DO - 10.1080/0284186x.2017.1401228

M3 - Journal article

C2 - 29168427

SN - 0284-186X

VL - 57

SP - 31

EP - 37

JO - Acta Oncologica

JF - Acta Oncologica

IS - 1

ER -