Prospects of neoadjuvant aromatase inhibitor therapy in breast cancer

Over 40% of breast cancer patients are older than 70 years of age. In the last three decades, several clinical trials have attempted to determine the most effective and well-tolerated systemic treatments, especially for elderly women. Tamoxifen had been the standard adjuvant endocrine treatment for postmenopausal women with hormone-sensitive breast cancer, but recent trials have shown advantages in using third-generation aromatase inhibitors. Patients with large, operable or locally advanced breast cancer are often treated initially with neoadjuvant therapy to reduce their tumor size and allow for breast-conserving surgery. Neoadjuvant chemotherapy has been widely studied, but little has been published on neoadjuvant endocrine therapy. This article reviews the use of neoadjuvant aromatase inhibitors in postmenopausal women with hormone-sensitive breast cancer.