open access

Vol 64, No 1 (2014)
Review paper
Published online: 2012-03-04
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Review of preoperative hormonal therapy in patients with breast cancer

Sylwia Dębska-Szmich, Magdalena Krakowska, Urszula Czernek, Maja Habib-Lisik, Agnieszka Zięba, Piotr Potemski
DOI: 10.5603/NJO.2014.0006
·
Nowotwory. Journal of Oncology 2014;64(1):40-47.

open access

Vol 64, No 1 (2014)
Review article
Published online: 2012-03-04

Abstract

Preoperative systemic treatment in patients with breast cancer enables conserving surgery in stage T3N0-1M0 or radical mastectomy in patients with primary inoperative tumor (T1-4N0-3M0). This treatment should be preceded by an accurate histopathological diagnosis with hormonal receptors profile, HER2 testing and evaluation of Ki67 expression. Also, precise staging should be performed and distant metastases should be excluded. In cases of conserving surgery, marking the tumor with a tattoo or a metal clip is obligatory.

According to recommendations of European Society of Medical Oncology (ESMO) the choice of preoperative pharmacotherapy should rather be based on predicted cancer responsiveness to the treatment than the poor risk factors resulting from the locally advanced stage of disease.

Complete remission confirmed by pathological examination after preoperative chemotherapy correlates with better prognosis. Patients with lumenal A subtype (hormonal receptors positive, HER2-negative, Ki67 < 14%) and hormonal receptor-positive lobular type of breast cancer hardly ever achieve pCR. If postmenopausal they are candidates for neoadjuvant hormonal therapy. In postmenopausal patients treatment with aromatase inhibitors is more effective than with tamoxifen regarding higher response rates and improvement of surgical options. However, it is still unknown, if aromatase inhibitors in a neoadjuvant setting improve survival when compared to tamoxifen. Preoperative hormonal therapy in premenopausal patients is controversial. There are no data from studies directly comparing efficacy and safety of preoperative hormonal therapy and chemotherapy.

This paper is a review of current studies about preoperative hormonal treatment of breast cancer.

Abstract

Preoperative systemic treatment in patients with breast cancer enables conserving surgery in stage T3N0-1M0 or radical mastectomy in patients with primary inoperative tumor (T1-4N0-3M0). This treatment should be preceded by an accurate histopathological diagnosis with hormonal receptors profile, HER2 testing and evaluation of Ki67 expression. Also, precise staging should be performed and distant metastases should be excluded. In cases of conserving surgery, marking the tumor with a tattoo or a metal clip is obligatory.

According to recommendations of European Society of Medical Oncology (ESMO) the choice of preoperative pharmacotherapy should rather be based on predicted cancer responsiveness to the treatment than the poor risk factors resulting from the locally advanced stage of disease.

Complete remission confirmed by pathological examination after preoperative chemotherapy correlates with better prognosis. Patients with lumenal A subtype (hormonal receptors positive, HER2-negative, Ki67 < 14%) and hormonal receptor-positive lobular type of breast cancer hardly ever achieve pCR. If postmenopausal they are candidates for neoadjuvant hormonal therapy. In postmenopausal patients treatment with aromatase inhibitors is more effective than with tamoxifen regarding higher response rates and improvement of surgical options. However, it is still unknown, if aromatase inhibitors in a neoadjuvant setting improve survival when compared to tamoxifen. Preoperative hormonal therapy in premenopausal patients is controversial. There are no data from studies directly comparing efficacy and safety of preoperative hormonal therapy and chemotherapy.

This paper is a review of current studies about preoperative hormonal treatment of breast cancer.

Get Citation
About this article
Title

Review of preoperative hormonal therapy in patients with breast cancer

Journal

Nowotwory. Journal of Oncology

Issue

Vol 64, No 1 (2014)

Article type

Review paper

Pages

40-47

Published online

2012-03-04

DOI

10.5603/NJO.2014.0006

Bibliographic record

Nowotwory. Journal of Oncology 2014;64(1):40-47.

Authors

Sylwia Dębska-Szmich
Magdalena Krakowska
Urszula Czernek
Maja Habib-Lisik
Agnieszka Zięba
Piotr Potemski

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