Neoadjuvant hormonal therapy for endocrine-sensitive breast cancer patients

This review assessed the effects of neoadjuvant hormonal therapy (NHT) in patients with endocrine-sensitive breast cancer.

Endocrine-sensitive breast cancer (also known as hormone receptor-positive breast cancer) refers to breast cancer cells which contain hormone receptors. These receptors (complexes on the surface of the cancer cells) stimulate cancer growth and spread in response to the hormones estrogen or progesterone. These receptors also allow doctors to treat the cancer with various drugs that influence the production or the effect of these hormones. This treatment strategy is referred to as hormonal therapy. Commonly used drugs for hormonal therapy include tamoxifen (nolvadex), which blocks the estrogen receptors, and aromatase inhibitors (AIs), which inhibit the production of estrogen.

Neoadjuvant hormonal therapy (NHT) refers to hormonal treatment given before surgery, in an attempt to shrink the tumor. Neoadjuvant treatment eases the surgical removal of the entire tumor and may allow for breast-conserving surgery (removal of the tumor alone instead of removing the entire breast). Usually, chemotherapy is used for the neoadjuvant treatment of breast cancer.

A total of 26 studies were analyzed in this review. Treatment duration ranged from 3 to 24 months. Tumor response rates to NHT varied widely, but were generally high for hormone receptor-positive patients. Clinical response rates (tumor shrinkage assessed by clinical signs and symptoms) ranged from 13.5% to 100%. Radiological response rates (tumor shrinkage measured by ultrasound or X-ray imaging) ranged from 16% to 91.7%.

Four studies compared NHT with neoadjuvant chemotherapy (NCT). NHT showed a clinical response rate that ranged from 48% to 89%, while NCT showed a clinical response rate that ranged from 64% to 85%. These differences were not shown to be statistically significant. An additional four studies compared the effect of two different hormonal therapies (tamoxifen versus AIs). NHT using AIs was generally superior in both tumor response rates and the rate of breast-conserving surgery. In most studies longer treatment durations (more than 3 months) were associated with better tumor response rates.

This review concluded that neoadjuvant hormonal therapy is effective in the treatment of endocrine-sensitive breast cancer and can be used as an alternative to neoadjuvant chemotherapy.

This review analyzed past studies, all employing different methods of treatment and examination. This might have resulted in some bias in the presented results.

Consult with your physician regarding the benefits of neoadjuvant therapy in the treatment of breast cancer.