Neoadjuvant endocrine therapy for breast cancer: state of the art

Abstract

In locally advanced breast cancer, neoadjuvant treatment has led to significant successes, which are of particular importance in the HER2-positive and triple-negative subtypes. However, its role in the treatment of luminal HER2-negative ER+/HER2-breast cancer is still under debate, due to low morphological complete response rates and limited significance of this factor as a predictor of long-term outcomes. At the same time, the administration of neoadjuvant chemotherapy to patients with locally advanced ER+/HER2-cancer is widely used in clinical practice. Neoadjuvant hormone therapy still holds untapped potential in the treatment of this subgroup of patients, especially in elderly and comorbid patients. In this paper, we present the results of neoadjuvant use of tamoxifen and/or aromatase inhibitors, as well as CDK4/6 and PI3K/mTOR inhibitors. We also discuss issues related to the optimal duration of treatment and show a comparison of the efficacy of neoadjuvant hormonal therapy and chemotherapy in different patient groups.