Abstract
It has generally been accepted that breast cancer (BC) cells are equally responsive to chemotherapy (CHT) irrespective of ER status. However, subset analyses of disease outcome in recently reported trials on neoadjuvant and adjuvant CHT brought new information about the issue. The subject of this paper is to review these data and to communicate our own results. NSABP B27 was designed to evaluate if adding of docetaxel (D) to conventional neoadjuvant doxorubicin-cyclophosphamide (AC) CHT improves the clinical response rate (cRR) and pathological RR (pRR) in BC patients treated with 4 AC cycles only. Although the adding of D to AC C.T significantly improved RR in both ER-negative and ER-positive BC patients, the pCR was significantly higher in ER-negative than in ER-positive group (16.7% vs. 8.3%) irrespective which regimen was used. ECTO trial and several neoadjuvant studies confirmed the significantly inferior RR to neoadjuvant C.T in ER-positive compared to ER-negative BC patients. Three large randomized Cancer and Leukemia Group B (CALGB) studies (CALGB 8541, CALGB 9344, and CALGB 9741) compared the efficacy of different adjuvant anthracycline-containing or anthracycline/taxane-containing regimens in BC patients. The absolute benefit in 5-year disease-free survival in ER-negative and ER-positive BC patients treated with adjuvant C.T were 22.8% and 7.0%, while corresponding absolute benefits in overall survival were 16.7% and 4.0%. The concept of equal sensitivity of ER-negative and ER-positive BC to CHT has been changing. The future task is to find BC patients with ER-positive BC with no benefit from CHT in whom endocrine therapy is the therapy of first choice. .
Highlights
Estrogen receptor (ER) have been recognized earlier as a weak prognostic factors [1], which means that women with ER-negative breast cancers (BC) have worse disease outcome without adjuvant systemic therapy in comparison to patients with ER-positive BC
NSABP B27 was designed to evaluate if adding of docetaxel (D) to conventional neoadjuvant doxorubicin-cyclophosphamide (AC) CHT improves the clinical response rate and pathological RR in BC patients treated with 4 AC cycles only
The future task is to find BC patients with ER-positive BC with no benefit from CHT in whom endocrine therapy is the therapy of first choice
Summary
Estrogen receptor (ER) have been recognized earlier as a weak prognostic factors [1], which means that women with ER-negative breast cancers (BC) have worse disease outcome without adjuvant systemic therapy in comparison to patients with ER-positive BC. The relationship between ER content and response to chemotherapy has received little attention since it has been generally accepted that ER-positive and ER-negative breast tumor cells are responsive to CHT [1]. Recent publications changed the common opinion about the benefit from CHT in ER-positive BC [5, 6], providing new data about less benefit from CHT, if at all, in patients with ER-positive BC Because of these new findings, the subject of this paper is to comment them and communicate our own results about the predictive role of ER in response to CHT of BC. As neoadjuvant chemotherapy does not prolong survival in patients with early BC [7], it is indicated only in those patients with large primary tumors to allow breast-conserving surgery. In ER-negative group AC+D and AC regimens achieved pCR in 22.8 % and 13.6% patients, respectively, while the corresponding results in ER-positive group were 14.1% and 5.7%, respectively
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