medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-32-29-34medalphabet-4107Research ArticleСтатьиВозможность органосохраняющей операции после неоадъювантной химиотерапии у больных гормон-положительным HER2-негативным раком молочной железыPossibility of breast-conserving surgery after neoadjuvant chemotherapy in patients with hormone-positive, HER2-negative breast cancerhttps://orcid.org/0000-0003-2050-142XЗанозинаE. A.ZanozinaE. A.

Занозина Екатерина Алексеевна, аспирант отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи

Москва

Zanozina Ekaterina A., postgraduate student at Dept of Oncology and Reconstructive Plastic Surgery of Breast and Skin 

Moscow 

zanozinaekaterina@gmail.comhttps://orcid.org/0000-0001-7141-2502ЗикиряходжаевА. Д.ZikiryakhodzhaevA. D.

Зикиряходжаев Азизжон Дильшодович, д.м.н., профессор, заведующий отделением онкологии и реконструктивно-пластической хирургии молочной железы и кожи, доцент кафедры онкологии, радиотерапии и пластической хирургии Института клинической медицины, профессор кафедры онкологии и рентгенорадиологии

Москва

Zikiryakhodzhaev Aziz D., DM Sci (habil.), head of Dept of Oncology and Reconstructive Plastic Surgery of Breast and Skin, associate professor at Dept of Oncology, Radiotherapy and Plastic Surgery, professor at Dept of Oncology and Radiology

Moscow 

azizz@mail.ruhttps://orcid.org/0000-0003-4879-2687БолотинаЛ. В.BolotinaL. V.

Болотина Лариса Владимировна, д.м.н., доцент РАН, заведующая отделением химиотерапии 

Москва

Bolotina Larisa V., DM Sci (habil.), head of Chemotherapy Dept 

Moscow 

lbolotina@yandex.ruhttps://orcid.org/0000-0003-0307-8252РассказоваЕ. А.RasskazovaE. V.

Рассказова Елена Александровна, к.м.н., научный сотрудник отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи

Москва

Rasskazova Elena V., PhD Med, researcher at Dept of Oncology and Reconstructive Plastic Surgery of Breast and Skin 

Moscow 

rasskaz2@yandex.ruhttps://orcid.org/0000-0001-8783-9738МаксимовК. В.MaksimovK. V.

Максимов Кирилл Владимирович, младший научный сотрудник отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи

Москва

Maksimov Kirill V., junior researcher, at Dept of Oncology and Reconstructive Plastic Surgery of Breast and Skin 

Moscow 

maksimov-kv@yandex.ruhttps://orcid.org/0009-0007-6233-5024СипкиВ. Н.SipkiV. N.

Сипки Вячеслав Нодарович, аспирант отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи 

Москва

Sipki Vyacheslav N., postgraduate student at Dept of Oncology and Reconstructive Plastic Surgery of Breast and Skin 

Moscow 

sipki1994@mail.ruМосковский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияNational Medical Research Radiological CentreRussian FederationМосковский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России ; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет) ; ФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»РоссияNational Medical Research Radiological Centre ; I.M. Sechenov First Moscow State Medical University (Sechenov University) ; Peoples’ Friendship University of Russia named after Patrice LumumbaRussian Federation202421012025032Диагностика и онкотерапия (4)2934Copyright © Занозина E.A., Зикиряходжаев А.Д., Болотина Л.В., Рассказова Е.А., Максимов К.В., Сипки В.Н., 20252025Занозина E.A., Зикиряходжаев А.Д., Болотина Л.В., Рассказова Е.А., Максимов К.В., Сипки В.Н.Zanozina E.A., Zikiryakhodzhaev A.D., Bolotina L.V., Rasskazova E.V., Maksimov K.V., Sipki V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4107

Целью исследования явился поиск данных об эффективности неоадъювантной лекарственной терапии у больных гормон-положительным HER2-негативным раком молочной железы.

Материал и методы

Материал и методы. Поиск литературы осуществлялся в базах данных PubMed, РИНЦ. Были найдены публикации с 2012 по 2024 г. Использовались ключевые слова: «breast cancer», «neoadjuvant chemotherapy», «surgery», «luminal tumors», «гормон-положительные опухоли», «органосохраняющая хирургия».

Результаты

Результаты. Рассматриваются показания к неоадъювантной химиотерапии у больных гормон-положительным HER2-негативным раком молочной железы, учитывая возможность достижения клинического и патоморфологического ответов с оценкой количества выполненных органосохраняющих операций, как основной задачи при назначении предоперационного лечения у данной группы пациентов, а также влияние патоморфологического ответа на показатели выживаемости.

Заключение

Заключение. Данные об эффективности неоадъювантной химиотерапии при гормон-положительном HER2-негативном раке молочной железы противоречивы. Частота полного патоморфологического ответа составляет 2,0–16,2%, прогностическая роль неоднозначна, однако большинство исследований показало отсутствие корреляции pCR с общей и безрецидивной выживаемостью. Выполнение органосохраняющей операции после неоадъювантной химиотерапии возможно в 50% случаев, если исключены другие противопоказания.

The aim of the study was to search for data on the effectiveness of neoadjuvant therapy hormone-positive HER2-negative breast cancer.

Material and methods

Material and methods. The literature search was conducted in PubMed and RISC databases. Publications from 2012 to 2024 were found. The keywords used were: “breast cancer”, “bneoadjuvant chemotherapy”, “bsurgery”, “bluminal tumors”, “bhormone-dependent tumors”, “bbreast-conserving surgery”.

Results

Results. The indications for neoadjuvant chemotherapy in patients with hormone-positive HER2-negative breast cancer are discussed, considering the possibility of achieving clinical and pathological response with the assessment of the number of performed breast-conserving surgeries as the main task when prescribing preoperative treatment in this group of patients, as well as the influence of pathological response on survival rates.

Conclusion

Conclusion. Data on the effectiveness of neoadjuvant chemotherapy for hormone-positive HER2-negative breast cancer are contradictory. The rate of complete pathological response is 2.0–16.2%, with its prognostic role being ambiguous. However, most studies have shown no correlation of pCR with overall and disease-free survival. The execution of breast-conserving surgery after neoadjuvant chemotherapy is possible in 50% of cases, if other contraindications are excluded.

рак молочной железынеоадъювантная химиотерапиягормон-положительные опухолиорганосохраняющие операцииpCRbreast cancerneoadjuvant chemotherapyhormone-positive tumorsbreast-conserving surgerypCRReferencesПод ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой Состояние онкологической помощи населению России в 2022 году.– М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2022.Edited by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova The state of oncological care for the population of Russia in 2022.– M.: P.A. Herzen Moscow Oncology Research Institute – branch of the Federal State Budgetary Institution «NMITs of Radiology» of the Ministry of Health of Russia, 2022. (In Russ.).Cortazar P, Zhang L, Untch M et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014 Jul 12;384(9938):164–72. doi: 10.1016/S0140–6736(13)62422-8.Cortazar P, Zhang L, Untch M et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014 Jul 12;384(9938):164–72. doi: 10.1016/S0140–6736(13)62422-8.Zujewski JA, Rubinstein L. CREATE-X a role for capecitabine in early-stage breast cancer: an analysis of available data. NPJ Breast Cancer. 2017 Jul 20;3:27. doi: 10.1038/s41523-017-0029-3.Zujewski JA, Rubinstein L. CREATE-X a role for capecitabine in early-stage breast cancer: an analysis of available data. NPJ Breast Cancer. 2017 Jul 20;3:27. doi: 10.1038/s41523-017-0029-3.von Minckwitz G, Huang CS, Mano MS et al; KATHERINE Investigators. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med. 2019 Feb 14;380(7):617–628. doi: 10.1056/NEJMoa1814017.von Minckwitz G, Huang CS, Mano MS et al; KATHERINE Investigators. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med. 2019 Feb 14;380(7):617–628. doi: 10.1056/NEJMoa1814017.von Minckwitz G, Untch M, Blohmer JU et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012 May 20;30(15):1796–804. doi: 10.1200/JCO.2011.38.8595.von Minckwitz G, Untch M, Blohmer JU et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012 May 20;30(15):1796–804. doi: 10.1200/JCO.2011.38.8595.Boughey JC, McCall LM, Ballman KV et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014 Oct;260(4):608–14 discussion 614–6. doi:10.1097/SLA.0000000000000924.Boughey JC, McCall LM, Ballman KV et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014 Oct;260(4):608–14 discussion 614–6. doi:10.1097/SLA.0000000000000924.Fayanju M.; Ren, Yi MS; Thomas, Samantha M. MS et al. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018 Oct;268(4):591–601. doi: 10.1097/SLA.0000000000002953.Fayanju M.; Ren, Yi MS; Thomas, Samantha M. MS et al. The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) After Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). Ann Surg. 2018 Oct;268(4):591–601. doi: 10.1097/SLA.0000000000002953.Hayashi N, Takahashi Y, Matsuda N et al. The Prognostic Effect of Changes in Tumor Stage and Nodal Status After Neoadjuvant Chemotherapy in Each Primary Breast Cancer Subtype. Clin Breast Cancer. 2018 Apr;18(2): e219-e229. doi: 10.1016/j.clbc.2017.09.013.Hayashi N, Takahashi Y, Matsuda N et al. The Prognostic Effect of Changes in Tumor Stage and Nodal Status After Neoadjuvant Chemotherapy in Each Primary Breast Cancer Subtype. Clin Breast Cancer. 2018 Apr;18(2): e219-e229. doi: 10.1016/j.clbc.2017.09.013.Hamy AS, Darrigues L, Laas E et al. Prognostic value of the Residual Cancer Burden index according to breast cancer subtype: Validation on a cohort of BC patients treated by neoadjuvant chemotherapy. PLoS One. 2020 Jun 24;15(6): e0234191. doi: 10.1371/journal.pone.0234191.Hamy AS, Darrigues L, Laas E et al. Prognostic value of the Residual Cancer Burden index according to breast cancer subtype: Validation on a cohort of BC patients treated by neoadjuvant chemotherapy. PLoS One. 2020 Jun 24;15(6): e0234191. doi: 10.1371/journal.pone.0234191.Guan, D., Jie, Q., Wu, Y. et al. Real-world data on breast pathologic complete response and disease-free survival after neoadjuvant chemotherapy for hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer: a multicenter, retrospective study in China. World J Surg Onc 20, 326 (2022). https://doi.org/10.1186/s12957-022-02787-9Guan, D., Jie, Q., Wu, Y. et al. Real-world data on breast pathologic complete response and disease-free survival after neoadjuvant chemotherapy for hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer: a multicenter, retrospective study in China. World J Surg Onc 20, 326 (2022). https://doi.org/10.1186/s12957-022-02787-9Семиглазов В.Ф., Семиглазов В.В., Дашян Г.А. и др. Неоадъювантная эндокринотерапия пациентов с эстроген-рецептор положительным раком молочной железы. Сибирский онкологический журнал. 2018; 17 (3): 11–19.– doi: 10.21294/1814-4861-2018-17-3-11-19Semiglazov V.F., Semiglazov V.V., Dashyan G.A. et al. NEOADJUVANT ENDOCRINE THERAPY FOR PATIENTS WITH ESTROGEN-RECEPTOR-POSITIVE BREAST CANCER. Siberian journal of oncology. 2018;17(3):11–19. (In Russ.) doi: 10.21294/1814-4861-2018-17-3-11-19Spronk, P.E.R., Volders, J.H., van den Tol, P. et al. 2019. Breast conserving therapy after neoadjuvant chemotherapy; data from the Dutch breast cancer audit. Eur. J. Surg. Oncol. 45, 110–117. doi: 10.1016/j.ejso.2018.09.027.Spronk, P.E.R., Volders, J.H., van den Tol, P. et al. 2019. Breast conserving therapy after neoadjuvant chemotherapy; data from the Dutch breast cancer audit. Eur. J. Surg. Oncol. 45, 110–117. doi: 10.1016/j.ejso.2018.09.027.Petruolo O, Sevilimedu V, Montagna G et al. How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery? Ann Surg Oncol. 2021 Jan;28(1):287–294. doi: 10.1245/s10434-020-08593-5.Petruolo O, Sevilimedu V, Montagna G et al. How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery? Ann Surg Oncol. 2021 Jan;28(1):287–294. doi: 10.1245/s10434-020-08593-5.Hage AN, Capriccioso C, Brennan J, Heiden B, Zheutlin A, Sabel MS. Impact of neoadjuvant chemotherapy on surgical outcomes among patients with hormone receptor positive breast cancer. J Surg Oncol. 2017 Nov;116(6):665–670. doi: 10.1002/jso.24721.Hage AN, Capriccioso C, Brennan J, Heiden B, Zheutlin A, Sabel MS. Impact of neoadjuvant chemotherapy on surgical outcomes among patients with hormone receptor positive breast cancer. J Surg Oncol. 2017 Nov;116(6):665–670. doi: 10.1002/jso.24721.Prakash I, Neely NB, Thomas SM et al. Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer. Cancer Med. 2022 Feb;11(4):1099–1108. doi: 10.1002/cam4.4517.Prakash I, Neely NB, Thomas SM et al. Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer. Cancer Med. 2022 Feb;11(4):1099–1108. doi: 10.1002/cam4.4517.Hosseini-Mellner S, Wickberg Å, Karakatsanis A et al. Impact of neoadjuvant compared to adjuvant chemotherapy on prognosis in patients with hormone-receptor positive / HER2-negative breast cancer: A propensity score matching population-based study. Breast. 2024 Aug; 76: 103741. doi: 10.1016/j.breast.2024.103741Hosseini-Mellner S, Wickberg Å, Karakatsanis A et al. Impact of neoadjuvant compared to adjuvant chemotherapy on prognosis in patients with hormone-receptor positive / HER2-negative breast cancer: A propensity score matching population-based study. Breast. 2024 Aug; 76: 103741. doi: 10.1016/j.breast.2024.103741Esgueva A, Siso C, Espinosa-Bravo M, et al. Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de-escalate surgical treatments. J Surg Oncol. 2020;1–9. https://doi.org/10.1002/jso.26236Esgueva A, Siso C, Espinosa-Bravo M, et al. Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de-escalate surgical treatments. J Surg Oncol. 2020;1–9. https://doi.org/10.1002/jso.26236Aktas A, Gunay-Gurleyik M, Aker F et al. Does neoadjuvant chemotherapy provide any benefit for surgical de-escalation in luminal B, HER2(–) breast cancers? Cir Cir. 2023;91(2):186–194. English. doi: 10.24875/CIRU.22000277.Aktas A, Gunay-Gurleyik M, Aker F et al. Does neoadjuvant chemotherapy provide any benefit for surgical de-escalation in luminal B, HER2(–) breast cancers? Cir Cir. 2023;91(2):186–194. English. doi: 10.24875/CIRU.22000277.Buus R, Sestak I, Kronenwett R, Ferree S et al. Molecular Drivers of Oncotype DX, Prosigna, EndoPredict, and the Breast Cancer Index: A TransATAC Study. J Clin Oncol. 2021 Jan 10;39(2):126–135. doi: 10.1200/JCO.20.00853.Buus R, Sestak I, Kronenwett R, Ferree S et al. Molecular Drivers of Oncotype DX, Prosigna, EndoPredict, and the Breast Cancer Index: A TransATAC Study. J Clin Oncol. 2021 Jan 10;39(2):126–135. doi: 10.1200/JCO.20.00853.McVeigh TP, Kerin MJ. Clinical use of the Oncotype DX genomic test to guide treatment decisions for patients with invasive breast cancer. Breast Cancer (Dove Med Press). 2017 May 29; 9: 393–400. doi: 10.2147/BCTT.S109847.McVeigh TP, Kerin MJ. Clinical use of the Oncotype DX genomic test to guide treatment decisions for patients with invasive breast cancer. Breast Cancer (Dove Med Press). 2017 May 29; 9: 393–400. doi: 10.2147/BCTT.S109847.Kantor O, Barrera E, Kopkash K et al. Are we Overtreating Hormone Receptor Positive Breast Cancer with Neoadjuvant Chemotherapy? Role of OncotypeDx® for Hormone Receptor Positive Patients Undergoing Neoadjuvant Chemotherapy. Ann Surg Oncol. 2019 Oct;26(10):3232–3239. doi: 10.1245/s10434–019–07555-w.Kantor O, Barrera E, Kopkash K et al. Are we Overtreating Hormone Receptor Positive Breast Cancer with Neoadjuvant Chemotherapy? Role of OncotypeDx® for Hormone Receptor Positive Patients Undergoing Neoadjuvant Chemotherapy. Ann Surg Oncol. 2019 Oct;26(10):3232–3239. doi: 10.1245/s10434–019–07555-w.Piccart M, van ‘t Veer LJ, Poncet C et al. 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol. 2021 Apr;22(4):476–488. doi: 10.1016/S1470–2045(21)00007-3.Piccart M, van ‘t Veer LJ, Poncet C et al. 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol. 2021 Apr;22(4):476–488. doi: 10.1016/S1470–2045(21)00007-3.Wang, J., Sang, D., Xu, B et al., 2019. Relationship between KI67 and the efficacy of neoadjuvant chemotherapy: Clinicopathological characteristics of luminal b breast cancer. International Journal of Clinical and Experimental Medicine, 12(5), 6044–6048Wang, J., Sang, D., Xu, B et al., 2019. Relationship between KI67 and the efficacy of neoadjuvant chemotherapy: Clinicopathological characteristics of luminal b breast cancer. International Journal of Clinical and Experimental Medicine, 12(5), 6044–6048Denkert C, Loibl S, Müller BM et al. Ki67 levels as predictive and prognostic parameters in pretherapeutic breast cancer core biopsies: a translational investigation in the neoadjuvant GeparTrio trial. Ann Oncol. 2013 Nov;24(11):2786–93. doi: 10.1093/annonc/mdt350.Denkert C, Loibl S, Müller BM et al. Ki67 levels as predictive and prognostic parameters in pretherapeutic breast cancer core biopsies: a translational investigation in the neoadjuvant GeparTrio trial. Ann Oncol. 2013 Nov;24(11):2786–93. doi: 10.1093/annonc/mdt350.von Minckwitz G, Schmitt WD, Loibl S et al. Ki67 measured after neoadjuvant chemotherapy for primary breast cancer. Clin Cancer Res. 2013 Aug 15;19(16):4521–31. doi: 10.1158/1078–0432.CCR-12–3628.von Minckwitz G, Schmitt WD, Loibl S et al. Ki67 measured after neoadjuvant chemotherapy for primary breast cancer. Clin Cancer Res. 2013 Aug 15;19(16):4521–31. doi: 10.1158/1078–0432.CCR-12–3628.Sueta, A., Yamamoto, Y., Hayashi, M., Yamamoto, S., Inao, T., Ibusuki, M., et al., 2014. Clinical significance of pretherapeutic Ki67 as a predictive parameter for response to neoadjuvant chemotherapy in breast cancer; is it equally useful across tumor subtypes? Surgery 155, 927–935. doi: 10.1016/j.surg.2014.01.009.Sueta, A., Yamamoto, Y., Hayashi, M., Yamamoto, S., Inao, T., Ibusuki, M., et al., 2014. Clinical significance of pretherapeutic Ki67 as a predictive parameter for response to neoadjuvant chemotherapy in breast cancer; is it equally useful across tumor subtypes? Surgery 155, 927–935. doi: 10.1016/j.surg.2014.01.009.

The authors declare that there are no conflicts of interest present.