Abstract
BackgroundTo investigate the efficacy of neoadjuvant chemotherapy (NCT), neoadjuvant endocrine therapy (NET) and neoadjuvant chemoendocrine therapy (NCET) on the tumour response, including pathological complete response (pCR) rate and overall response rate (ORR), in postmenopausal women with hormone receptor (HR)-positive breast cancer.MethodsBased on a PRISMA-IPD statement, the PubMed, Embase and Cochrane Library databases were used to identify eligible trials published from inception to 7 May 2019. Pooled odds ratio (OR) with 95% confidential interval (CI) was calculated to assess the pCR rate and ORR of tumours among those three treatments via fixed- or random-effect Mantel-Haenszel models in terms of a Heterogeneity Chi2 test with a significant level of p < 0.1. All statistical tests were performed by the software of StataSE, version 12.0.ResultsThe analysed data consisted of 10 eligible clinical trials with 971 unique HR-positive breast cancer patients. The pooled results indicated that the pCR rate of those patients undergoing NET was significantly lower than those undergoing NCT (pooled OR, 0.48; 95% CI, 0.26–0.90), whereas the difference of ORR between both therapies was not statistically significant (pooled OR, 1.05; 95% CI, 0.73–1.52). The combined paradigm of NCET compared with the monotherapy of NET or NCT did not present a significantly improved pCR rate or ORR (pooled OR, 2.61; 95% CI, 0.94–7.25; and 2.25; 95% CI, 0.39–13.05; respectively).ConclusionPostmenopausal HR-positive breast cancer patients after NCT may have better tumour response than those after NET, while those undergoing NCET may not manifest the apparently improved clinical efficacies compared to those receiving monotherapy.
Highlights
To investigate the efficacy of neoadjuvant chemotherapy (NCT), neoadjuvant endocrine therapy (NET) and neoadjuvant chemoendocrine therapy (NCET) on the tumour response, including pathological complete response rate and overall response rate (ORR), in postmenopausal women with hormone receptor (HR)-positive breast cancer
A multicenter phase II study by the Japan Breast Cancer Research Group (JBCRG) demonstrated that the achievement of pathological complete response (pCR) in HR-positive breast cancer women who received NCT predicted favourable disease-free survival (DFS) [5]. These results suggest that pCR, overall response rate (ORR) and other biomarkers can be used as valid surrogate endpoints to predict long-term survival in patients after neoadjuvant treatment
Search strategy According to the PRISMA-IPD Statement [15], electronic searching was performed in databases including PubMed, Cochrane Library and Embase using the following retrieval strategy: ((neoadjuvant endocrine therapy) odds ratio (OR) OR OR OR OR OR OR OR) AND ((breast neoplasms) OR OR OR OR) AND AND ((hormone receptor positive) OR OR OR OR OR OR Luminal) AND (pCR OR OR ORR OR OR OR OR)
Summary
To investigate the efficacy of neoadjuvant chemotherapy (NCT), neoadjuvant endocrine therapy (NET) and neoadjuvant chemoendocrine therapy (NCET) on the tumour response, including pathological complete response (pCR) rate and overall response rate (ORR), in postmenopausal women with hormone receptor (HR)-positive breast cancer. Neoadjuvant therapy for hormone receptor (HR)-positive breast cancer includes neoadjuvant chemotherapy (NCT), neoadjuvant endocrinotherapy (NET) and neoadjuvant chemoendocrine therapy (NCET) After these treatments, unresectable tumours can be made amenable to mastectomy, and the initially operable ones in requirement of mastectomy may be operated on in order to avoid sacrificing the breast via lumpectomy, thereby greatly extending long-term survival and improving the quality of life. A multicenter phase II study by the Japan Breast Cancer Research Group (JBCRG) demonstrated that the achievement of pCR in HR-positive breast cancer women who received NCT predicted favourable DFS [5] These results suggest that pCR, overall response rate (ORR) and other biomarkers can be used as valid surrogate endpoints to predict long-term survival in patients after neoadjuvant treatment
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