Impact of endocrine therapy on overall survival in ER negative/PR positive locoregional breast cancer: An analysis of the National Cancer Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 545-545
Author(s):  
Vidya Kollu ◽  
Kohei Osterloth ◽  
Andrew J. Borgert ◽  
Susan M. Frankki ◽  
Benjamin Marshall Parsons
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Endocrine Therapy ◽  
Stage I ◽  
Her2 Status ◽  
Matched Cohort ◽  
Cancer Data ◽  
Her2 Breast Cancer ◽  
Definitive Surgery

545 Background: Breast cancer expressing PR, but not ER (ER-/PR+) are uncommon, comprising 2–8% of breast cancers, with less known about their characteristics and responsiveness to therapy. The role of adjuvant endocrine therapy (ET) in ER-/PR+ locoregional breast cancer is unclear as these patients have been largely excluded from prospective clinical trials. Despite a lack of data patients are often treated with adjuvant ET due to perceived possible benefit. We used the National Cancer Data Base (NCDB) to assess role of adjuvant ET in ER-/PR + breast cancer. Methods: Using the NCDB, we included adults ≥ 18 and ≤ 70 years old in order to minimize the non-cancer related deaths. We selected only female patients with stage I, II, and III. Patients have received definitive surgery (lumpectomy with radiation or mastectomy) with negative margins. Systemic therapy (ST) was defined as receipt of chemotherapy and/or immunotherapy. We excluded those who had unknown ST status, unknown ET status, unknown HER 2 status, who did not receive definitive surgery and those whose survival time was missing. Patients were stratified into four groups based on HER2 status and receipt of ET. Both Multivariable Cox proportional hazards regression modeling was utilized to determine predictors of overall survival (OS). A propensity score matched cohort was developed based on relevant demographic and clinical factors. The primary endpoint assessed was OS. All analyses were performed using SAS 9.4. Results: We identified 5344 patients (74% were Caucasian, 20% were African American and 6% were others) with ER-/PR+(74% were HER2 - and 26% were HER2 +) locoregional breast cancer (51% were Stage I, 38 % were stage II and 11% were stage III). Grade 1 cancer was seen in 2%, grade 2 in 18%, and majority being grade 3 in 80%. Of which 3093 (58%) patients received ET and 4462 (83%) received ST. Majority of patients were in age group 50-70 comprising of 69% patients, 8 % in age 18—39, 23% in age 40-49 with Charlson-Deyo Score of 0 in 83%, 1 in13%, 2-3 in 4%. In a propensity matched cohort (N=3980), ET was not significantly associated with OS among HER2 negative (HER2-) patients (HR=1.05, 95% CI 0.86-1.28, p=0.63). In HER2+ patient ET was associated with significantly improved OS (HR=0.65, 95% CI 0.42-0.99, p=.047). Conclusions: Receiving ET was not associated with improved OS in locoregional ER-/PR+/HER2- breast cancer based on our study using a propensity matched cohort in the NCDB. However, was frequently administered. Interestingly, improved OS was seen in locoregional ER-/PR+/HER2+ breast cancer with adjuvant ET.

Effect of hormone receptor status and local treatment on overall survival for early-stage breast cancer.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 60-60
Author(s):  
Catherine Parker ◽  
Heather Y. Lin ◽  
Yu Shen ◽  
Liang Li ◽  
Meeghan Ann Lautner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Cox Model ◽  
Local Treatment ◽  
Local Therapy ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Matched Cohort ◽  
Double Robust

60 Background: Mastectomy and breast conserving therapy (BCT) have been established as interventions with equivalent survival for early stage breast cancer. However, trials comparing these approaches pre-date the understanding of breast cancer heterogeneity. We hypothesized that if heterogeneity is considered, the surgical approach may impact survival. Methods: Using the National Cancer Database (NCDB) from 2004 to 2005, we evaluated the overall survival (OS) of women with Stage I breast cancer who underwent mastectomy, BCT (surgery with radiation), or breast conserving surgery (BCS, surgery without radiation). Since only ER and PR data were available, we categorized tumors as ER and/or PR positive (HR+) or ER and PR negative (HR-). We performed propensity score-matched analysis using the covariates associated with the choice of surgical therapy. We used the Cox proportional hazards model for analyses of OS in pre-matched and matched cohorts. Double robust estimation under the Cox model was used in the analyses of the matched cohort. Results: A total of 16,646 female patients met study criteria: 1,845 (11%) received BCS, 11,214 (67%) received BCT, and 3,587 (22%) underwent mastectomy. Patients undergoing BCT had superior survival outcomes compared to those undergoing mastectomy or BCS (5-year OS was 96% vs 90% vs 87% respectively, p<0.001). After adjusting for other risk factors, BCT remained significantly associated with OS (HR 0.57 [95% CI 0.50, 0.66] for BCT vs BCS; HR 0.67 [95% CI 0.6, 0.76] for BCT vs mastectomy). In the matched cohort (1706 patients in each treatment group), comparison of OS in multivariate analysis confirmed the survival benefit associated with BCT over mastectomy (HR 0.73 [95% CI, 0.59, 0.89]) in the HR+ subset but not in the HR- subset (HR 0.91 [95%CI 0.62, 1.34]) of patients. BCT showed better OS than BCS in both HR+ and HR- subsets (HR 0.63 [95% CI, 0.52, 0.77], HR 0.67 [95%CI 0.46, 0.98] respectively). No differences were seen in OS between mastectomy and BCS in either HR+ or HR- cohorts (HR 0.87 [95%CI. 0.73, 1.03]), HR 0.73 [95%CI 0.51, 1.06] respectively). Conclusions: When tumor heterogeneity is considered, type of local therapy appears to impact the survival of women with Stage I breast cancer.

scholarly journals Predictive role of HER2-status on the effectiveness of endocrine adjuvant treatment in postmenopausal breast cancer patients: a population-based cohort study

2020 ◽  
Author(s):  
Aglaia Schiza ◽  
Davide Mauri ◽  
Irma Fredriksson ◽  
Anna-Karin Wennstig ◽  
Antonios Valachis
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Endocrine Therapy ◽  
Population Based ◽  
Her2 Status ◽  
Her2 Positive ◽  
Study Results

Abstract Purpose There are conflicting results on the potential role of HER2-status on the efficacy of aromatase inhibitors (AIs) and tamoxifen (TAM) in patients with hormone receptor (HR)-positive breast cancer (BC). The purpose of this population-based cohort study was to investigate the potential benefit of AIs compared to TAM as adjuvant therapy in postmenopausal BC patients by HER2-status in the era of modern therapy with HER2-blockade. Methods A population-based cohort study was performed including all postmenopausal women diagnosed with HR-positive BC without distant metastasis between 2007 and 2012 in three healthcare regions in Sweden. We analyzed the breast cancer-specific survival (BCSS) and overall survival (OS) in two distinct cohorts (HER2-negative, HER2-positive) based on the type of endocrine therapy (ET) used. A propensity score matching was performed separately in the HER2-negative and HER2-positive cohorts, respectively. Results After propensity score matching, 4368 patients with HER2-negative and 214 patients with HER2-positive BC were available for analysis. In the HER2-negative cohort, an improved BCSS [Hazard Ratio (HR): 0.51; 95% confidence interval (CI): 0.34–0.77, p value < 0.001] and a trend toward improved OS (HR: 0.66; 95% CI: 0.41–1.08, p value = 0.093) in favor of AI-based therapy was observed. In the HER2-positive cohort, no statistically significant difference between AI-based ET and TAM was found in terms of either BCSS or OS, although the direction of HR was similar as in the HER2-negative cohort (HR for BCSS: 0.84; 95% CI: 0.14–5.04, p = 0.849; HR for OS: 0.62; 95% CI: 0.10–3.38, p = 0.345). Conclusion Our study results, based on propensity-matched cohorts, did not support any predictive value of HER2-status on endocrine therapy in postmenopausal BC patients. AI-based ET remains the treatment of choice for postmenopausal BC patients with HR-positive disease in the modern era of HER2-directed therapy irrespective of HER2-status.

Prognostic and predictable value of COX2 expression in Russian women with stage I breast cancer.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 80-80
Author(s):  
Irina Vladimirovna Kolyadina ◽  
P. J. K. Kuppen ◽  
Cornelis J. H. Van De Velde ◽  
Irina Vladimirovna Poddubnaya ◽  
N.G. Dekker-Ensink ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Prognostic Value ◽  
Adjuvant Endocrine Therapy ◽  
Histological Type ◽  
Stage I ◽  
Her2 Status ◽  
Cancer Stage ◽  
Er Positive ◽  
Cox2 Expression

80 Background: Some previous studies found worse prognosis among cyclooxygenase-2 (COX2)-expressing breast cancers; we study prognostic and predictiable value of COX2 expression in breast cancer stage I. Methods: our study included Russian women with breast cancer stage I (n=315) treated in RCRC, RMAPE (1985-2009). A Tissue Micro Array (TMA) with triplicate 1 mm tumor tissue punches taken from tumor blocks was constructed in LUMC; sections were immunohistochemically stained for ER, PR, HER2-status, Ki67 (by standard morphological criteria); COX2-expression were evaluated as positive (>median; 31/309 cases, 10%) or negative (≤median; 278/209 cases, 90%). Also the histological type, grade, age and adjuvant endocrine therapy were examined. We analyzed the clinic and morphological data of COX2-positive tumors, prognostic value for survival (relapses free- RFS, overall- OS and cancer specific- CSS) and predictable value for endocrine therapy. Results: COX2-positive tumor were associated with ductal histological type (p=0,018), PR-negative status (p=0,027) and high Ki67 (p<0,0001), but not correlated (p>0,05) with age, grade, ER, HER2 status or biological subtype. In women with ER-negative tumors (104 patients, 34,1%) COX2-expression did not associate with worse survival (p>0,05). In contrast to this, in patients with ER-positive tumors (201 women, 65,9%) COX2-expression strongly correlated with worse RFS in univariate (HR 2,829, 95% CI 1,366-5,860, p=0,005) and multivariate analyses (HR=2,972, 95% CI 1,190-7,423, p=0,02). The same value of COX2-expression in women with ER-positive tumors was found for CSS (univariate: HR 3,421, 95% CI 1,436-8,149, p=0,005; multivariate: HR 4,260, 95% CI 1,344-13,504, p=0,014), but not for OS (p>0,05). In women who did not receive adjuvant endocrine therapy (145 patients, 46%) COX2 expression did not have any prognostic value for RFS, OS and CSS (p>0,05) but in patients that used adjuvant endocrine therapy (170 women, 54%) COX2-expression strongly associated with worse cancer-specific survival (HR 5,614 95% CI 1,165-27,059, p=0,032), but not with RFS and OS (p>0,05). Conclusions: COX2 expression plays a role in hormonal pathways and sensitivity for endocrine therapy.

Addition of endocrine therapy to dual anti-HER2 targeted therapy in initial treatment of HER2+/HR+ metastatic breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1038-1038
Author(s):  
Matthew Loft ◽  
Sheau Wen Lok ◽  
Richard H. De Boer ◽  
Laeeq Malik ◽  
Sally Greenberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Targeted Therapy ◽  
Endocrine Therapy ◽  
De Novo ◽  
Performance Status ◽  
Metastatic Breast ◽  
First Line

1038 Background: The combination of dual anti-HER2 targeted therapy and chemotherapy is the current first line standard of care for HER2+ metastatic breast cancer. Endocrine therapy (ET) is the backbone of treatment in hormone receptor positive (HR+) disease, but the role of the addition of endocrine therapy following chemotherapy in HER2+/HR+ disease remains unclear as pivotal first line clinical trials excluded endocrine therapy use. Methods: Data from a multi-site community cohort of consecutive HER2+ metastatic breast cancer patients diagnosed between 1 January 2012 and 31 August 2019 was examined. Patients were treated at clinician discretion. The subset of patients eligible for this analysis were those that were HR+ and had received first line dual anti-HER2 targeted therapy. Results: Of 132 eligible patients included in the analysis, 78 (59.1%) received endocrine therapy and 54 (40.9%) did not. Median follow up was 25.9 months. There were no significant differences between the two groups based on age, performance status, previous therapy or de novo disease (Table), however, patients with bone metastases were more likely to receive ET in conjunction with first line dual anti-HER2 therapy (71% vs 52%, p= .043). The addition of ET was associated with improved progression free (HR 2.1, 95% CI 1.2-3.5, p = 0.007) and overall survival (HR 2.7, 95% CI 1.2-5.5, p = 0.007) in multivariate analysis. No increase in serious adverse events was noted although endocrine therapy related toxicities were not specifically collected. Conclusions: In this real-world series, the addition of ET to first line dual anti-HER2 therapy in HER2+/HR+ metastatic breast cancer was associated with improved progression free and overall survival. Further research is required to validate these findings and examine the role of CDK4/6 inhibitors in this disease, but may provide reassurance to clinicians considering ET in this clinical context. [Table: see text]

De-escalated chemotherapy versus endocrine therapy plus pertuzumab+ trastuzumab for HR+/HER2+ early breast cancer (BC): First efficacy results from the neoadjuvant WSG-TP-II study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 515-515
Author(s):  
Oleg Gluz ◽  
Ulrike Nitz ◽  
Matthias Christgen ◽  
Sherko Kuemmel ◽  
Johannes Holtschmidt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Histological Grade ◽  
Prospective Trial ◽  
Neoadjuvant Treatment ◽  
Her2 Status ◽  
Multivariable Logistic Regression Analysis ◽  
Continuous Variables ◽  
Her2 Breast Cancer ◽  
Prospective Comparison

515 Background: HR+/HER2+ breast cancer (BC) is a distinct entity associated with better prognosis compared to HR-/HER2+ BC. However, combination of chemotherapy (CT) with (dual) anti-HER2 blockade is standard in HER2+ early BC (EBC), irrespective of HR-status. Despite of some promising data on combination of endocrine therapy (ET) with dual anti-HER2 blockade in EBC and metastatic HR+/HER2+ BC, no prospective comparison of neoadjuvant CT vs. ET + dual HER2-blockade has yet been performed. Methods: In the prospective WSG TP-II phase II-trial (NCT03272477; Sponsor: Palleos GmbH, Wiesbaden, Germany), 207 patients (pts) (257 screened; 40 centers) with centrally confirmed HR+/HER2+ EBC were randomized to 12 weeks of standard ET (n=100) vs. paclitaxel 80 mg/m2 weekly (n=107) +trastuzumab+pertuzumab q3w for all pts. Primary endpoint was pCR (ypT0/is/ypN0). Secondary endpoints include safety, disease-free and overall survival, translational research, and quality of life (QoL). Omission of further CT was allowed in all pts with pCR; dual HER2-blockade was administered in the adjuvant setting in all pts. Results: Baseline characteristics were well balanced between the arms. Median age was 53 years; 58% had cT2-4, 28% had cN+; 43% had G3 tumors. pCR data were available in 198 pts (ET: n=96; Pac: n=102). pCR was observed in 24% (95% CI: 16-34%) with ET+T+P vs. 57% (95% CI:47-67%) with Pac+T+P (OR 0.24, 95% CI: 0-0.46, p<0.001). In multivariable logistic regression analysis and corresponding sensitivity analysis (bootstrap/subsample inclusion frequencies and lasso regression) including study arm, BMI, menopausal, cT, and cN status, histological grade, HER2-status, Ki67, ER, PR as continuous variables, only study arm and HER2 3+ status were significantly associated with pCR. Neoadjuvant treatment was well tolerated in both study arms and completed per protocol in 93/92 (ET+P+T/Pac+P+T) patients. Only 9/13 SAEs (ET+P+T/Pac+P+T) were reported during neoadjuvant therapy. PAM50 and QoL analysis are ongoing. Conclusions: WSG TP-II is the first randomized prospective trial comparing two neoadjuvant de-escalation treatments in HR+/HER2+ EBC. The excellent pCR rate of 57% after only 12 weeks of Pac+P+T was clearly superior to the still promising 24% pCR rate in pts treated by ET+P+T. In both arms, treatment efficacy was most pronounced in HER2 3+ tumors. Survival results need to be awaited before definite recommendations for a de-escalated regimen in HR+/HER2+ EBC can be made. Clinical trial information: 2016-005157-21 .

Role of 21- gene recurrence score in patients age ≥70 with T1N0 ER/PR+ HER2- breast cancer treated with breast-conserving surgery and endocrine therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 571-571
Author(s):  
Neil Chandrabhan Chevli ◽  
Waqar Haque ◽  
Kevin Thomas Tran ◽  
Andrew M. Farach ◽  
Mary R. Schwartz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Recurrence Score ◽  
Breast Conserving Surgery ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer ◽  
Kaplan Meier ◽  
Node Negative Breast Cancer ◽  
Cox Proportional Hazard Models

571 Background: Based on the results of the CALGB 9343 trial, patients age ≥70 with T1N0 ER/PR+ HER2- breast cancer who are treated with breast conserving surgery (BCS) and endocrine therapy (ET) are candidates for omission of radiotherapy (RT). This trial predated the 21- gene RT-PCR recurrence score (RS) test, which is an assay now available for patients with hormone receptor positive, HER2 negative, node negative breast cancer to determine who will benefit from chemotherapy. Whether the RS can predict for patients most likely to benefit from radiation therapy (RT) following BCS has not been previously examined. The purpose of this study was to use a large database of patients age ≥70 with T1N0 ER/PR+ HER2- disease to determine if RS could predict who would benefit from RT following BCS. Methods: The National Cancer Database (NCDB) was queried (2004-2017) for female patients age ≥70 with pT1N0 ER+ PR+ HER2- breast cancer treated with BCS and ET and who had an available RS. Patients were stratified based on their RS (low risk [LR] = 1-10, intermediate risk [IR] = 11-25, high risk [HR] = 26-99). For survival analysis, propensity score matching (PSM) was conducted overall and for each group to create 1:1 matched cohorts of patients who received radiotherapy and patients who did not. Kaplan-Meier analysis with log-rank testing was used to evaluate overall survival (OS). Univariable (UVA) and multivariable (MVA) analysis were conducted using Cox proportional hazard models to determine which clinical and treatment factors were prognostic for OS. Results: A total of 13,614 patients met the selection criteria: 3,840 in the LR cohort, 8,383 in the IR cohort, and 1,391 in the HR cohort. A total of 79% received RT: 77% in the LR cohort, 79% in the IR cohort, and 85% in the HR cohort. Because PSM could not be efficiently performed in the HR cohort alone, the IR and HR cohort were merged (IRHR) for matching. After PSM, overall the 5-year OS was 90% for those who received RT and 88% for those who did not (p = 0.03). The 5-year OS in the LR cohort was 89% for those who received RT and 89% for those who did not (p = 0.517). In the IRHR cohort, the 5-year OS was 93% for those who received RT and 88% for those who did not (p = 0.004). On MVA in the overall cohort, RT (p = 0.037) was predictive of improved OS while increasing age (p < 0.001) and CDCC comorbidity score (p < 0.001) were predictive of worse OS. On MVA in the LR cohort, RT (p = 0.602) was not predictive of improved OS. However, on MVA in the IRHR cohort, RT (p = 0.004) was a positive prognostic factor for OS. Conclusions: This is the first study investigating the role of RS in this subset of patients eligible for omission of radiotherapy. There is an OS benefit with the use of RT in patients with IRHR RS, but not in patients with LR RS. Pending prospective evaluation, assessment of RS in this older subset of patients is recommended with consideration of RT when RS is ≥11.

scholarly journals Regulatory Interplay between miR-181a-5p and Estrogen Receptor Signaling Cascade in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 543
Author(s):  
Rosaria Benedetti ◽  
Chiara Papulino ◽  
Giulia Sgueglia ◽  
Ugo Chianese ◽  
Tommaso De Marchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Endocrine Therapy ◽  
Mirna Expression ◽  
Estrogen Receptor Alpha ◽  
Estrogen Signaling ◽  
Integrated Analysis ◽  
Tumor Resistance ◽  
Estrogen Receptor Signaling

The efficacy and side effects of endocrine therapy in breast cancer (BC) depend largely on estrogen receptor alpha (ERα) expression, the specific drug administered, and treatment scheduling. Although the benefits of endocrine therapy outweigh any adverse effects in the initial stages of BC, later- or advanced-stage tumors acquire resistance to treatments. The mechanisms underlying tumor resistance to therapy are still not well understood, posing a major challenge for BC patient care. Epigenetic regulation and miRNA expression may be involved in the switch from a treatment-sensitive to a treatment-resistant state and could provide a valid therapeutic strategy for ERα negative BC. Here, a hybrid lysine-specific histone demethylase inhibitor, MC3324, displaying selective estrogen receptor down-regulator-like activities in BC, was used to highlight the interplay between epigenetic and ERα signaling. MC3324 anticancer action is mediated by microRNA (miRNA) expression regulation, indicating an innovative function for this molecule. Integrated analysis suggests a crosstalk between estrogen signaling, ERα interactors, miRNAs, and their putative targets. Specifically, miR-181a-5p expression is regulated by MC3324 and has an impact on cellular levels of ERα. A comparison of breast tumor versus healthy mammary tissues confirmed the important role of miR-181a-5p in ERα regulation and points to its putative predictive function in BC therapy.

scholarly journals The Emerging Role of Extracellular Vesicles in Endocrine Resistant Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1160
Author(s):  
Giusi La Camera ◽  
Luca Gelsomino ◽  
Amanda Caruso ◽  
Salvatore Panza ◽  
Ines Barone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Extracellular Vesicles ◽  
Molecular Mechanisms ◽  
Endocrine Resistance ◽  
Disease Recurrence ◽  
Estrogen Receptor Α ◽  
Research Area ◽  
Tumor Evolution

Breast cancer is the most common solid malignancy diagnosed in females worldwide, and approximately 70% of these tumors express estrogen receptor α (ERα), the main biomarker of endocrine therapy. Unfortunately, despite the use of long-term anti-hormone adjuvant treatment, which has significantly reduced patient mortality, resistance to the endocrine treatments often develops, leading to disease recurrence and limiting clinical benefits. Emerging evidence indicates that extracellular vesicles (EVs), nanosized particles that are released by all cell types and responsible for local and systemic intercellular communications, might represent a newly identified mechanism underlying endocrine resistance. Unraveling the role of EVs, released by transformed cells during the tumor evolution under endocrine therapy, is still an open question in the cancer research area and the molecular mechanisms involved should be better defined to discover alternative therapeutic approaches to overcome resistance. In this review, we will provide an overview of recent findings on the involvement of EVs in sustaining hormonal resistance in breast cancer and discuss opportunities for their potential use as biomarkers to monitor the therapeutic response and disease progression.

scholarly journals Top 3 abstracts concerning hormone-receptor-positive early breast cancer

2021 ◽  
Author(s):  
Simon Peter Gampenrieder ◽  
Gabriel Rinnerthaler ◽  
Richard Greil
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Menopausal Status ◽  
Pathologic Complete Response ◽  
Oncotype Dx ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer

SummaryThe three top abstracts at the 2020 virtual San Antonio Breast Cancer Symposium regarding hormone-receptor-positive early breast cancer, from our point of view, were the long-awaited results from PenelopeB and RxPONDER as well as the data from the ADAPT trial of the West German Study Group. PenelopeB failed to show any benefit by adjuvant palbociclib when added to standard endocrine therapy in patients without pathologic complete response after neoadjuvant chemotherapy. RxPONDER demonstrated that postmenopausal patients with early hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) breast cancer, 1–3 positive lymph nodes and an Oncotype DX Recurrence Score of less than 26 can safely be treated with endocrine therapy alone. In contrast, in premenopausal women with positive nodes, adjuvant chemotherapy plays still a role even in case of low genomic risk. Whether the benefit by chemotherapy is mainly an indirect endocrine effect and if ovarian function suppression would be similarly effective, is still a matter of debate. The HR+/HER2− part of the ADAPT umbrella trial investigated the role of a Ki-67 response to a short endocrine therapy before surgery in addition to Oncotype DX—performed on the pretreatment biopsy—to identify low-risk patients who can safely forgo adjuvant chemotherapy irrespective of menopausal status.

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