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Evaluating the Role of Neoadjuvant Endocrine Therapy in Breast Cancer

Sara M. Tolaney, MD, MPH
Published Online:6:08 PM, Thu August 1, 2019

Sara M. Tolaney, MD, MPH, Dana-Farber Cancer Institute, discusses the evolving role of neoadjuvant endocrine therapy in the breast cancer space. She says there is particular interest in using this therapy in patients with HER2-positive and triple-negative breast cancer, but it can be more challenging in patients with ER-positive disease.

Using the responses of preoperative therapy can help physicians adapt adjuvant therapy regimens and improve responses in patients, Tolaney says. However, patients with ER+ disease do not achieve pathologic complete responses as often in this setting. The development of surrogate biomarkers helps in learning how to use neoadjuvant endocrine therapy.

Neoadjuvant endocrine therapy has been associated with improved rates of breast conservation. This therapy is also less toxic than neoadjuvant chemotherapy. The biggest challenge with this therapy is selecting which patients will benefit better from the endocrine therapy versus chemotherapy, says Tolaney. 

There is currently a lot of biomarker research to help improve patient selection for therapy, says Tolaney. The utilization of biomarkers such as Ki67 may be predictive of early response or PEPI scores at time of surgery. In addition, some physicians are using genomic assays of the core biopsy to inform treatment decisions.
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