Neoadjuvant endocrine treatment in breast cancer: analysis of daily practice in large cancer center to facilitate decision making

• Published in: The American journal of surgery Vol. 208; no. 5; pp. 756 - 763
• Main Authors: Debled, Marc, M.D, Auxepaules, Gaël, M.D, de Lara, Christine Tunon, M.D, Garbay, Delphine, M.D, Brouste, Véronique, M.Sc, Bussières, Emmanuel, M.D., Ph.D, Mauriac, Louis, M.D, MacGrogan, Gaëtan, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014; Elsevier Limited
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Aromatase Inhibitors - therapeutic use; Breast cancer; Breast neoplasms; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast-conserving surgery; Cancer therapies; Chemotherapy; Chemotherapy, Adjuvant; Decision Making; Endocrine therapy; Female; Humans; Mastectomy, Segmental - statistics & numerical data; Metastasis; Middle Aged; Neoadjuvant endocrine therapy; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Participation; Patients; Retrospective Studies; Shared decision making; Statistical methods; Studies; Surgery; Survival Analysis; Tamoxifen - therapeutic use; Treatment Outcome; Tumors; Shared decision making; Breast neoplasms; Breast-conserving surgery; Neoadjuvant endocrine therapy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2013.12.032

Abstract Background To examine outcomes of neoadjuvant endocrine therapy in daily practice to inform decision making. Methods We retrospectively selected 204 patients who received neoadjuvant endocrine therapy with T2 (≥30 mm) or T3 tumors, examining subsequent breast-sparing surgery and long-term outcomes. Results Neoadjuvant endocrine therapy was administered for 7.3 months (median) and breast-sparing surgery was achievable in 53% of patients. Smaller initial tumor size and modified version of the Scarff–Bloom and Richardson grades 1 to 2 were associated with breast-sparing surgery. Disease progression during treatment was 6.9%; actuarial risk of local relapse was 3% at 5 years and 15% at 10 years. Five- and 10-year metastasis relapse-free survival was 78% and 63%, respectively. Grade 3, negative progesterone receptors, and absence or slow response to neoadjuvant therapy were associated prognostic factors. Conclusion These daily practice data provide important information about feasibility, efficacy, and long-term results of neoadjuvant endocrine therapy and can be used to inform patients for decision making between mastectomy and endocrine induction therapy.