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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2016; 38(12): 615-622
DOI: 10.1055/s-0036-1597579
Review Article
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Multidisciplinary Approach to Neoadjuvant Endocrine Therapy in Breast Cancer: A Comprehensive Review

Abordagem multidisciplinar em hormonioterapia neoadjuvante no câncer de mama: uma revisão
Tomás Reinert
1   Department of Medical Oncology, Hospital do Câncer Mãe de Deus, Porto Alegre, RS, Brazil
2   Centro de Pesquisa da Serra Gaúcha, Caxias do Sul, RS, Brazil
3   Post-Graduation Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
,
Susana Ramalho
4   Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Rodrigo Gonçalves
5   Department of Obstetrics and Gynecology, School of Medicine, Universidade de São Paulo, SP, Brazil
,
Carlos Henrique Barrios
6   School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
,
Marcia Silveira Graudenz
7   Pathology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
8   Instituto de Patologia, Porto Alegre, RS, Brazil
,
José Bines
9   Department of Medical Oncology, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
› Author Affiliations
Further Information

Publication History

17 July 2016

20 October 2016

Publication Date:
21 December 2016 (online)

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Abstract

Breast cancer is the most common type of cancer and the leading cause of cancer-related death among women worldwide. Hormone receptor-positive (HR+) tumors represent the most common form of this disease, with more than 70% of breast cancers expressing these receptors. Response and benefit to neoadjuvant chemotherapy (NCT) varies according to HR expression, with lower responses in luminal tumors as compared with hormone receptor-negative (HR-) and human epidermal growth factor receptor 2-positive (HER2+) tumors. Neoadjuvant endocrine therapy (NET) is an option for selected patients with HR+ locally advanced breast cancer. Neoadjuvant endocrine therapy has a favorable toxicity profile, and is associated with benefits such as having low cost and being more easily available even for cancer care professionals outside major urban areas or tertiary centers. These factors are particularly relevant, as 70% of breast cancer deaths occur in women from low-income and middle-income countries. Additionally, NET is being increasingly explored, not simply to allow for less extensive surgery, but also as a scientific tool, with the use of biomarkers to predict outcomes in adjuvant trials and for the individual patient. This review details the current and most relevant evidence about NET for breast cancer as well as the future directions of this field.

Resumo

O câncer de mama é o mais comum, e a principal causa de mortalidade por câncer em mulheres de todo o mundo. Os tumores com receptor hormonal (RH) positivo representam o tipo mais comum desta doença. O benefício e as taxas de resposta à quimioterapia neoadjuvante variam de acordo com a expressão de RH, sendo mais baixa nos tumores luminais em comparação com tumores HER2 positivos ou triplo-negativos. A hormonioterapia neoadjuvante, uma opção para pacientes selecionados com tumores RH positivo localmente avançados, apresenta melhor perfil de tolerabilidade e segurança, e está associada com benefícios adicionais, como baixo custo e fácil acesso. Estes fatores são relevantes, uma vez que 70% das mortes por câncer de mama acontecem em mulheres de países pobres ou em desenvolvimento. Além disso, a hormonioterapia neoadjuvante vem sendo explorada como uma ferramenta científica, ao possibilitar o estudo de biomarcadores que podem predizer desfechos tanto para pacientes individuais quanto para ensaios clínicos em adjuvância. Este artigo de revisão detalha o conhecimento atual e as evidências mais relevantes sobre hormonioterapia neoadjuvante em câncer de mama, assim como perspectivas futuras nesta área.

Keywords

breast neoplasm - drug therapy - tamoxifen - aromatase inhibitors

Palavras-chave

neoplasias da mama - farmacoterapia - tamoxifeno - inibidores da aromatase

Methods Supplement

A descriptive synthesis was planned, as we did not expect the data to be sufficiently homogeneous to allow for direct comparisons and definitive statements. Our objective was to perform a comprehensive review focused on the most important patient care related aspects.


Selected trials included in a recently published systematic review and meta-analysis were evaluated.[19] Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Spring et al[19] selected twenty prospective, randomized, neoadjuvant clinical trials that reported response rates with at least one arm incorporating NET.


In our analysis, ten studies were considered: three studies comparing NET monotherapy with AIs and combination NCT for localized breast cancer, and seven studies comparing NET monotherapy with different endocrine agents. Trials evaluating NET with growth factor pathway inhibitors and studies without direct comparison were not included.


 

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