What is the role of neoadjuvant hormone therapy in the treatment of breast cancer?

Updated: May 21, 2019
  • Author: Erin V Newton, MD; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

The best candidates for neoadjuvant chemotherapy are ER-negative or HER2-positive expressing tumors in which pCR rates are generally above 20% and predict long-term survival. Patients with ER-positive, HER2-negative LABC are unlikely to achieve a pCR from currently available chemotherapy, and the best approach for these patients is likely to involve building on a backbone of hormone therapy, either alone or in combination with targeted agents.

There has been little experience in the United States with neoadjuvant hormone therapy, although this approach has been tested in several clinical trials in Europe. Neoadjuvant hormone therapies appear to be very effective in shrinking tumor size to enable breast-conserving surgery, but pCR is rare.

A study by Fitzal et al determined that breast conserving therapy is oncologically safe after tumor downsizing via neoadjuvant chemotherapy in patients primarily scheduled for mastectomy. [55] However, the authors of that study advise that patients should not receive breast conserving therapy without a demonstrated response after neoadjuvant therapy.

A study by Jacobs et al determined that using multimodality proton, (23)Na MRI, and positron emission tomography (PET)/CT scanning metrics as radiological biomarkers is to monitor response to neoadjuvant chemotherapy is feasible. [56]


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