Neoadjuvant hormonal therapy

For elderly patients with ER positive tumors endocrine therapy is an acceptable alternative to chemotherapy with similar response rates and less toxicity.

Neoadjuvant endocrine therapy in postmenopausal women with ER +HER2 neg locally advanced breast cancer is equivocal to neoadjuvant chemotherapy as far locoregional and overall outcomes (wright JL).

NHT could downsize hormone receptor positive breast tumors and facilitate breast conserving with efficacy.

Trials comparing neuroendocrine therapy with neoadjuvant chemotherapy in hormone receptor positive negative HER2 negative breast cancer demonstrated similar clinical and radiological response and breast conserving surgery.

Neoadjuvant endocrine therapy trials provide opportunities to assess endocrine sensitivities in treatment naïve early stage ER positive/ERBB2 negative breast cancer as resistance can be defined by tumor Ki 67 greater than 10% following 2 to 4 weeks of neoadjuvant endocrine therapy.

This is prospectively a validated biomarketrfor increased recurrence risk in postmenopausal individuals.

A higher degree of Ki67 suppression in randomized neoadjuvant, endocrine trials, predict, improve efficacy of AI compared to tamoxifen.

The pathological stage, residual tumor Ki67 and ER levels, following four to six months of neoadjuvant AI or tamoxifen treatment are independent prognostic factors that lead to the development of the pre-operative endocrine prognostic index to determine the risk of relapse.




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