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Abstract
Introduction. Selecting a treatment strategy for patients with Estrogen-Receptor-positive, HER2-negative Breast Cancer (ER+HER2-BC) is a complex therapeutic challenge. Previous studies have shown that the outcomes of neoadjuvant endocrine therapy (NET) and combined chemotherapy (CT) are comparable in terms of breast-conserving surgery rates and clinical response. However, no direct comparisons have been conducted between modern anthracycline–taxane chemotherapy (A-T NACT) and NET with regard to RCB (Residual Cancer Burden). The role of NET in de-escalating chemotherapy also remains unclear.
Aim. A comparative assessment of the frequency of pathological Complete Response (pCR), RCB 0+1, and axillary pCR during NET compared to A-T NACT in stage II–III BC in postmenopausal patients. RCB 0+1 was chosen as an endpoint due to comparable long-term outcomes in ER+HER2- BC based on meta-analysis data.
Materials and Methods. A retrospective single-center study included patients with stage II–III ER+HER2-BC who underwent NET or NACT at a single center between August 2018 and November 2023.
Results. A total of 206 patients were included in the study: 96 received NET with AI, and 110 underwent A-T NACT. After pseudo-randomization, 69 patients from each group were included in the final analysis. The majority (94.2–91.3 %) had stage III disease. The median age was 64.6–58.2 years, and the median Ki67 was 34.2–39.5 %. The pCR rate was 1.4 % in the NET group vs 10.1 % in the NACT group (p = 0.06), RCB 0+1 was 4.3 vs 20.2 % (p = 0.008), and axillary clearance was 3.5 vs 27.6 % (p < 0.001). After surgery, 53.6 % of NET patients received adjuvant chemotherapy (ACT), while 46.3 % did not. The three-year Event-Free Survival (EFS) was 92.8 vs 87.0 % (p = 0.6).
Conclusion. Our preliminary results suggest that NET has a significantly lower rate of RCB 0+1 and axillary clearance than A-T NACT. However, it does not translate into differences in EFS so far, probably due to adjuvant CT, which was administered to 53.6 % of patients. NET allowed to avoid CT in 46.3 % of patients or de-escalate it (to 6 or 4xTC) in 23.2 %.
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