eISSN: 3087-405X editor@aimjournals.com
All Journals
Submit your article

International Research Journal of Medical Sciences and Health Care

Open Access Peer Review International
Open Access

Using Short-Term Preoperative Endocrine Therapy to Inform Adjuvant Treatment Choices in Premenopausal HR-Positive HER2-Negative Breast Cancer

DOI https://doi.org/10.55640/irjmshc-v03i03-02
PDF
Almuradova D.M. 1 ORCID iD , Ravshanova N.B. 1 ORCID iD , Ismoilov J.X. 1 ORCID iD ,
4 Phd. Associate Professor of Oncology, Onkogematology And Radiation Oncology Department. Tashkent State of Medical University. Uzbekistan
4 Medical Oncology. Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, Tashkent, Republic of Uzbekistan
4 Аssistаnt Оf Thе Dераrtmеnt Оf Оnсоlоgу, Onkogematology And Radiation Oncology. Tаshkеnt Stаtе Mеdiсаl Univеrsitу, Tаshkеnt, Uzbеkistаn

Abstract

Limited access to genomic testing necessitates alternative approaches to guide adjuvant treatment decisions in patients with early-stage luminal HER2-negative breast cancer. Studies such as IMPACT and POETIC have demonstrated that a reduction in Ki-67 to ≤10% after a short (2–4 weeks) course of endocrine therapy (ET) is associated with favorable prognosis in postmenopausal patients. In some cases, this allows omission of chemotherapy (CT), thereby avoiding its toxicity. However, evidence for this strategy in premenopausal patients remains scarce.

Objective: To evaluate the impact of a short preoperative “test” course of endocrine therapy on subsequent treatment decisions in premenopausal women with primary operable luminal HER2-negative breast cancer (T1–3N0–1M0).

Materials and Methods: A retrospective analysis was conducted including premenopausal patients treated at Center of Oncology Uzbekistan between 2020 and 2023. All patients had operable luminal HER2-negative breast cancer and received a 2–4 week course of neoadjuvant endocrine therapy prior to surgery.

Results: A total of 250 patients were analyzed. The mean age was 44±6 years. Among patients with initially elevated Ki-67 (>10%), 19.2% demonstrated a reduction to ≤10% after endocrine therapy. Independent predictors of response included age ≥50 years and baseline Ki-67 <30% (p<0.01). According to the PREDICT model, 37.2% of patients had a high expected benefit (>5%) from chemotherapy; however, 20.4% of these patients were able to avoid chemotherapy following Ki-67 reduction. Conversely, among patients with low expected benefit from chemotherapy, 25.6% still received it.

Conclusion: A short “test” course of endocrine therapy in premenopausal patients with luminal HER2-negative breast cancer represents a feasible and reproducible tool for personalizing adjuvant treatment strategies. Further prospective validation is required.

Keywords

Hormone receptor–positive HER2-negative breast cancer, test endocrine therapy, adjuvant therapy

References

📄 Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249. doi:10.3322/caac.21660.
📄 Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000;406:747–752. doi:10.1038/35021093
📄 Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, et al. Young age at diagnosis correlates with worse prognosis and distinct gene expression profiles in breast cancer. J Clin Oncol. 2009;27(20):3324–3329. doi:10.1200/JCO.2008.19.1527
📄 Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317(23):2402–2416. doi:10.1001/jama.2017.7112
📄 Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111–121. doi:10.1056/NEJMoa1804710
📄 Cardoso F, van’t Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S, et al. 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375:717–729. doi:10.1056/NEJMoa1602253
📄 Parker JS, Mullins M, Cheang MC, Leung S, Voduc D, Vickery T, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol. 2009;27(8):1160–1167. doi:10.1200/JCO.2008.18.1370
📄 MINDACT Trial Investigators. Clinical utility of the 70-gene signature (MammaPrint) in early-stage breast cancer: 5-year results from the MINDACT trial. N Engl J Med. 2016;375:717–729. doi:10.1056/NEJMoa1602253
📄 TAILORx Investigators. Effect of chemotherapy in addition to endocrine therapy in women with hormone-receptor-positive, HER2-negative, node-negative breast cancer with a mid-range 21-gene recurrence score. N Engl J Med. 2018;379:111–121. doi:10.1056/NEJMoa1804710
📄 Wishart GC, Azzopardi J, Gilani R, Abraham J, Pinder SE, Heller W, et al. Neoadjuvant endocrine therapy in ER-positive breast cancer: a systematic review. Lancet Oncol. 2010;11:871–879. doi:10.1016/S1470-2045(10)70112-5
📄 Dowsett M, Smith IE, Ebbs SR, Dixon JM, Skene A, A’Hern R, et al. Prognostic value of Ki67 expression after short-term presurgical endocrine therapy for primary breast cancer (IMPACT trial). J Natl Cancer Inst. 2005;97:1037–1045. doi:10.1093/jnci/dji179
📄 Dowsett M, Smith IE, Bartlett J, Brain E, A’Hern R, Hills M, et al. Ki67 after short-term presurgical endocrine therapy predicts recurrence-free survival in breast cancer: POETIC trial. Lancet Oncol. 2020;21:125–136. doi:10.1016/S1470-2045(19)30762-1
📄 Harbeck N, Rastogi P, Martin M, Dubsky P, Schem C, Fasching PA, et al. Individualized strategies for preoperative endocrine therapy: results of the ADAPT trial. J Clin Oncol. 2021;39:2746–2758.doi:10.1200/JCO.21.00243

Most read articles by the same author(s)

1 2 > >>