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Neoadjuvant Endocrine Therapy Compared to Neoadjuvant Chemotherapy in Node-Positive HR+, HER2- Breast Cancer (Nodal
Mahtab Vasigh1,2,3, Mohammadreza Karoobi2, Austin D Williams1
1Department of Surgical Oncology Fox Chase Cancer Center, Philadelphia, PA, USA.
Introduction:
Patients with hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancers have the lowest response to neoadjuvant therapy of all subtypes. The role of neoadjuvant endocrine therapy (NET) in clinically node-positive (cN+), HR+, HER2- patients is evaluated in this meta-analysis.
Methods:
This study was performed between January 2010 and August 2022. We evaluated the node pathologic complete response (pCR) and axillary lymph node dissection (ALND) rates after neoadjuvant endocrine therapy (NET).
Results:
18,037 HR+, HER2-, cN+ stage II and stage III breast cancer patients within eleven studies received neoadjuvant treatments. 3,707 (20.6%) patients received NET and 14,330 (79.4%) received NAC. The average age of the NET patients was higher than that of the neoadjuvant chemotherapy (NAC) patients (64.1 versus 47.6 years old, p < 0.001). 45.0% and 26.9% of the NET and the NAC groups underwent a lumpectomy. The pooled estimates of node pCR in NET and NAC groups were 8.9% and 14.9%, and the pooled proportion of ALND was 39.1% and 58.5%, respectively.
Conclusion:
The rate of node pCR was lower among cN+ patients who received NET compared to the NAC group. The rate of ALND among cN+ NET patients was lower than the NAC group, revealing more patients with residual nodal disease do not get ALND in the NET group. Further prospective studies are required to compare survival outcomes as a more reliable surrogate.
Insights
Neoadjuvant endocrine therapy (NET) shows lower node complete response rates and less axillary lymph node dissection (ALND) in hormone receptor-positive breast cancer patients compared to neoadjuvant chemotherapy (NAC). Further research is needed to assess survival outcomes.
Area of Science:
- Oncology
- Breast Cancer Research
- Clinical Trials
Background:
- Hormone receptor-positive (HR+), HER2-negative breast cancer has limited response to neoadjuvant therapy.
- Neoadjuvant endocrine therapy (NET) is an option for clinically node-positive (cN+) patients.
Purpose of the Study:
- To evaluate the role and outcomes of neoadjuvant endocrine therapy (NET) in cN+, HR+, HER2- breast cancer patients.
- To compare node pathologic complete response (pCR) and axillary lymph node dissection (ALND) rates between NET and neoadjuvant chemotherapy (NAC).
Main Methods:
- Meta-analysis of eleven studies including 18,037 patients with stage II and III HR+, HER2-, cN+ breast cancer.
- Evaluated node pCR and ALND rates in patients receiving NET (3,707) versus NAC (14,330).
- Data collected between January 2010 and August 2022.
Main Results:
- The NET group had a lower pooled node pCR rate (8.9%) compared to the NAC group (14.9%).
- The pooled proportion of ALND was significantly lower in the NET group (39.1%) versus the NAC group (58.5%).
- Patients receiving NET were older on average (64.1 years) than those receiving NAC (47.6 years).
Conclusions:
- Neoadjuvant endocrine therapy (NET) resulted in lower node pCR rates in cN+ HR+ breast cancer patients compared to neoadjuvant chemotherapy (NAC).
- Lower ALND rates in the NET group suggest more patients with residual nodal disease may not undergo dissection.
- Prospective studies are necessary to compare survival outcomes and validate these findings.
