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Published on: May 24, 2024
Neoadjuvant therapy for ER-positive breast cancers.
1Department of Medicine, Research Unit in Medical Senology, European Institute of Oncology, Milan, Italy. marco.colleoni@ieo.it
Summary
Tailoring neoadjuvant therapy for ER-positive, HER-2-negative operable breast cancer based on tumor grade and proliferation improves treatment selection. This personalized approach optimizes chemotherapy or endocrine therapy strategies for better patient outcomes.
Area of Science:
- Oncology
- Translational Research
- Precision Medicine
Background:
- ER-positive, HER-2-negative operable breast cancer is heterogeneous, necessitating personalized treatment strategies.
- Pathological features like grade, ER, PgR expression, and Ki67 index predict response to neoadjuvant therapies.
- Current treatment algorithms for operable breast cancer require refinement for optimal neoadjuvant selection.
Framework:
- Tumor subtypes are identified using grade, estrogen receptor (ER), progesterone receptor (PgR), and Ki67 labeling index.
- Treatment selection is guided by tumor characteristics, differentiating between high and low proliferative/grade tumors.
- Specialized breast cancer subtypes may benefit from adjuvant endocrine therapy alone.
Implementation:
- High-grade or high-proliferative tumors warrant neoadjuvant chemotherapy, including anthracyclines and taxanes.
- Postmenopausal patients with low-grade/proliferative, high-ER/PgR tumors may receive neoadjuvant endocrine therapy for 4-8 months.
- Tailored neoadjuvant treatments are recommended for ER-positive tumors, considering safety, quality of life, and patient preferences.
Implications:
- Personalized neoadjuvant treatment selection can enhance pathologic complete response rates.
- Optimized neoadjuvant endocrine therapy offers an alternative to chemotherapy for specific patient groups.
- Routine discussion of safety, quality of life, and patient preferences is crucial for shared decision-making in breast cancer treatment.
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