| You are here: Home: BCU 4|2002: Program Supplement: Neoadjuvant systemic therapy
| Neoadjuvant
Systemic Therapy |
|
| Oncologists: The following patients
with 2.8 centimeter, ER-positive, HER2- negative breast
cancers desire breast-conserving surgery; however, their
breasts are too small to allow a good cosmetic outcome
with lumpectomy at the present time. Which neoadjuvant
regimen would you use?
(See next page for choice of hormonal
therapy) |
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A majority of oncologists would use neoadjuvant systemic therapy
of some kind in these patients. Note the frequent use (40-75%) of
neoadjuvant chemotherapy alone or in combination with hormonal therapy,
re g a rdless of the patient’s age. The most commonly utilized
neoadjuvant chemotherapy regimen is AC. Elderly patients are the
only group in whom endocrine therapy alone is used to a significant
extent.
Aapro MS. Neoadjuvant therapy in breast cancer: Can we define
its role? Oncologist 2001;6 Suppl 3:36-9. Abstract
Gianni Let al. Adjuvant and neoadjuvant treatment of breast
cancer. Semin Oncol 2001;28 ( 1 ) : 13-29. Abstract
Mamounas EP, Fisher B. Preoperative (neoadjuvant) chemotherapy
in patients with breast cancer. Semin Oncol 2001;28(4):389-99.
Abstract
Smith IC, Miller ID. Issues involved in research into the neoadjuvant
treatment of breast cancer. Anticancer Drugs 2001;12
Suppl 1:S25-9. Abstract
| Neoadjuvant
Endocrine Therapy |
|
| Oncologists: Of those using
preoperative endocrine therapy, which therapy would
you use in the following women with 2.8 cm, ER-positive,
HER2- negative breast cancers?
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The inappropriate use of aromatase inhibitors in premenopausal
women is most striking. These agents are indicated for postmenopausal
women only. Also of note in postmenopausal women, aromatase inhibitors
are used more often than tamoxifen, reflecting recently reported
neoadjuvant studies indicating greater efficacy. Of the a romatase
inhibitors, anastrozole is more widely utilized among oncologists
than other agents.
Cheung KLet al. Preoperative endocrine therapy for breast cancer.
Endocr Relat Cancer 2000;7(3):131-41. Full-text
Dixon JM et al. The effects of neoadjuvant anastrozole (Arimidex)
on tumor volume in postmenopausal women with breast cancer: A randomized,
double-blind, single-center study. Clin Cancer Res 2000;6(6):2229-35.
Abstract
Ellis MJ et al. Letrozole is more effective neoadjuvant endocrine
therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen
receptor-positive primary breast cancer: Evidence from a phase III
randomized trial. J Clin Oncol 2001;19:3808-16. Abstract
Geisler J et al. Influence of neoadjuvant anastrozole (Arimidex)
on intratumoral estrogen levels and proliferation markers in patients
with locally advanced breast cancer. Clin Cancer Res
2001;7:1230-6. Abstract
Milla-Santos A et al. Anastrozole (A) as neoadjuvant (NEO)
therapy for hormone-dependent locally advanced breast cancer (LABC)
in postmenopausal (PM) patients (pts). Breast Cancer Res
Treat 2001; Abstract
302.
| Neoadjuvant
Chemotherapy and Trastuzumab |
|
| Oncologists: Would you utilize
neoadjuvant chemotherapy and/or trastuzumab in the following
women with ER-negative, HER2-positive breast cancers?
|
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There are many ongoing randomized clinical trials of neoadjuvant
chemotherapy with and without trastuzumab. A significant number
of oncologists (35-65%) state that they would use trastuzumab in
the neoadjuvant setting at the present time in a non protocol setting.
Of the physicians using neoadjuvant trastuzumab and chemotherapy,
30-50% would use a cytotoxic regimen containing an anthracycline,
despite concerns of cardiotoxicity with these agents in combination.
Baselga J. Current and planned clinical trials with trastuzumab
(Herceptin). Semin Oncol 2000; 27 (5 Suppl 9):27-32.
Abstract
Burstein HJ et al. Preoperative trastuzumab (T) and paclitaxel
(P) for HER2 overexpressing (HER2+) stage II/III breast cancer:
Clinical, pathological and serological findings. Breast Cancer
Res Treat 2001; Abstract
507.
Carey LA et al. Safety and efficacy of 4AC followed by paclitaxel
plus trastuzumab in high risk breast cancer patients. Proc
ASCO 2001 ; Abstract
1856.
Stebbing JJ, Gaya A. The evidence-based use of induction chemotherapy
in breast cancer. Breast Cancer 2001;8(1):23-37. Abstract
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