Neoadjuvant chemotherapy and hormonal therapy for locally advanced luminal HER2-negative breast cancer

Background. Treatment of locally advanced breast cancer (BC) should start with systemic therapy to achieve the possibility of surgical intervention. In luminal HER2-negative BC, 2 options for neoadjuvant systemic therapy are possible – chemotherapy and hormonal therapy. To date, there are no clear criteria for choosing the most optimal treatment option for a particular patient.

Objective. To evaluate the efficacy of neoadjuvant hormone therapy (NHT) and chemotherapy (NCT) for patients with intermediate expected hormone sensitivity (high levels of ER/RP and Ki67>30% or low levels of ER/RP and Ki67<30%)

Materials and methods. The study involved 75 pre- and postmenopausal patients with locally advanced luminal HER2-negative breast cancer who received NHT (tamoxifen/aromatase inhibitors) or NCT (4 cycles of AC and taxanes) in the preoperative period. The primary endpoint was a decrease in Ki67 levels by 50% or more.

Results. The NGT group included 39 patients, the NCT group – 36 patients. Taking into account differences in patient characteristics between the groups, pseudorandomization (propensity matching analysis) was performed for correct comparison, after which 23 patients remained in each group. Operability was achieved in 87% of patients in the NHT group and 91.3% in the NCT group (p = 0.25). A decrease in Ki67 by 50% or more was noted in 47.1% of cases in the NHT group and in 57.1% in the NCT group (p = 0.284), and a decrease to <10% – in 42.9% and 35.3% of cases, respectively (p = 0.66). The frequency of achieving complete pathomorphological regression (pCR) was 10% with NHT and 14.3% with NCT. The 4-year disease-free survival (DFS) with a median follow-up of 46 months in the NHT group was 89.1%, in the NCT group – 84.8% (p = 0.693).

Conclusions. Neoadjuvant chemotherapy and hormonal therapy demonstrate similar efficacy in patients with intermediate hormone sensitivity in terms of the frequency of significant decrease in Ki67, achievement of pCR, DFS rates.

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