What Is the Role of Neoadjuvant Endocrine Therapy for Breast Cancer?


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Advances in Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fisher B.
        • Brown A.
        • Mamounas E.
        • et al.
        Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National surgical adjuvant breast and bowel project B-18.
        J Clin Oncol. 1997; 15: 2483-2493
        • van der Hage J.A.
        • van de Velde C.J.
        • Julien J.P.
        • et al.
        Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902.
        J Clin Oncol. 2001; 19: 4224-4237
        • Gianni L.
        • Baselga J.
        • Eiermann W.
        • et al.
        Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European cooperative trial in operable Breast Cancer.
        J Clin Oncol. 2009; 27: 2474-2481
        • Boughey J.C.
        • Suman V.J.
        • Mittendorf E.A.
        • et al.
        Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial.
        JAMA. 2013; 310: 1455-1461
        • Kuehn T.
        • Bauerfeind I.
        • Fehm T.
        • et al.
        Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study.
        Lancet Oncol. 2013; 14: 609-618
        • Boileau J.F.
        • Poirier B.
        • Basik M.
        • et al.
        Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study.
        J Clin Oncol. 2015; 33: 258-264
        • Classe J.M.
        • Loaec C.
        • Gimbergues P.
        • et al.
        Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study.
        Breast Cancer Res Treat. 2019; 173: 343-352
        • von Minckwitz G.
        • Huang C.S.
        • Mano M.S.
        • et al.
        Trastuzumab emtansine for residual invasive HER2-positive breast cancer.
        N Engl J Med. 2019; 380: 617-628
        • Masuda N.
        • Lee S.J.
        • Ohtani S.
        • et al.
        Adjuvant capecitabine for breast cancer after preoperative chemotherapy.
        N Engl J Med. 2017; 376: 2147-2159
        • Sparano J.A.
        • Gray R.J.
        • Makower D.F.
        • et al.
        Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer.
        N Engl J Med. 2018; 379: 111-121
        • Kalinsky K.
        • Barlow W.E.
        • Meric-Bernstam F.
        • et al.
        Abstract GS3-00: First results from a phase III randomized clinical trial of standard adjuvant endocrine therapy (ET) +/- chemotherapy (CT) in patients (pts) with 1-3 positive nodes, hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) < 25: SWOG S1007 (RxPonder).
        Cancer Res. 2021; 81 (GS3-00-GS3-00)
        • Semiglazov V.F.
        • Semiglazov V.V.
        • Dashyan G.A.
        • et al.
        Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer.
        Cancer. 2007; 110: 244-254
        • Alba E.
        • Calvo L.
        • Albanell J.
        • et al.
        Chemotherapy (CT) and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from the GEICAM/2006-03, a multicenter, randomized, phase-II study.
        Ann Oncol. 2012; 23: 3069-3074
        • Spring L.M.
        • Gupta A.
        • Reynolds K.L.
        • et al.
        Neoadjuvant endocrine therapy for estrogen receptor-positive breast cancer: a systematic review and meta-analysis.
        JAMA Oncol. 2016; 2: 1477-1486
        • Bates T.
        • Riley D.L.
        • Houghton J.
        • et al.
        Breast cancer in elderly women: a cancer research Campaign trial comparing treatment with tamoxifen and optimal surgery with tamoxifen alone. The elderly breast cancer working party.
        Br J Surg. 1991; 78: 591-594
        • Fennessy M.
        • Bates T.
        • MacRae K.
        • et al.
        Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer.
        Br J Surg. 2004; 91: 699-704
        • Mustacchi G.
        • Milani S.
        • Pluchinotta A.
        • et al.
        Tamoxifen or surgery plus tamoxifen as primary treatment for elderly patients with operable breast cancer: The G.R.E.T.A. Trial. Group for Research on Endocrine Therapy in the Elderly.
        Anticancer Res. 1994; 14: 2197-2200
        • Mustacchi G.
        • Ceccherini R.
        • Milani S.
        • et al.
        Tamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial.
        Ann Oncol. 2003; 14: 414-420
        • Eiermann W.
        • Paepke S.
        • Appfelstaedt J.
        • et al.
        Preoperative treatment of postmenopausal breast cancer patients with letrozole: A randomized double-blind multicenter study.
        Ann Oncol. 2001; 12: 1527-1532
        • Smith I.E.
        • Dowsett M.
        • Ebbs S.R.
        • et al.
        Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial.
        J Clin Oncol. 2005; 23: 5108-5116
        • Cataliotti L.
        • Buzdar A.U.
        • Noguchi S.
        • et al.
        Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer: the Pre-Operative "Arimidex" Compared to Tamoxifen (PROACT) trial.
        Cancer. 2006; 106: 2095-2103
        • Ellis M.J.
        • Suman V.J.
        • Hoog J.
        • et al.
        Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype--ACOSOG Z1031.
        J Clin Oncol. 2011; 29: 2342-2349
        • Gu Y.L.
        • Pan S.M.
        • Ren J.
        • et al.
        Role of magnetic resonance imaging in detection of pathologic complete remission in breast cancer patients treated with neoadjuvant chemotherapy: a meta-analysis.
        Clin Breast Cancer. 2017; 17: 245-255
        • Takeda K.
        • Kanao S.
        • Okada T.
        • et al.
        MRI evaluation of residual tumor size after neoadjuvant endocrine therapy vs. neoadjuvant chemotherapy.
        Eur J Radiol. 2012; 81: 2148-2153
        • Laws A.
        • Hughes M.E.
        • Hu J.
        • et al.
        Impact of residual nodal disease burden on technical outcomes of sentinel lymph node biopsy for node-positive (cN1) breast cancer patients treated with neoadjuvant chemotherapy.
        Ann Surg Oncol. 2019; 26: 3846-3855
        • Mamtani A.
        • Barrio A.V.
        • King T.A.
        • et al.
        How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? results of a prospective study.
        Ann Surg Oncol. 2016; 23: 3467-3474
        • Cortazar P.
        • Zhang L.
        • Untch M.
        • et al.
        Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis.
        Lancet. 2014; 384: 164-172
        • Weiss A.
        • Wong S.
        • Golshan M.
        • et al.
        Patterns of Axillary management in stages 2 and 3 hormone receptor-positive breast cancer by initial treatment approach.
        Ann Surg Oncol. 2019; 26: 4326-4336
        • Hammond J.B.
        • Parnall T.H.
        • Scott D.W.
        • et al.
        Gauging the efficacy of neoadjuvant endocrine therapy in breast cancer patients with known axillary disease.
        J Surg Oncol. 2020; 122: 619-622
        • Montagna G.
        • Sevilimedu V.
        • Fornier M.
        • et al.
        How effective is neoadjuvant endocrine therapy (NET) in downstaging the axilla and achieving breast-conserving surgery?.
        Ann Surg Oncol. 2020; 27: 4702-4710
        • Murphy B.M.
        • Hoskin T.L.
        • Degnim A.C.
        • et al.
        Surgical management of axilla following neoadjuvant endocrine therapy.
        Ann Surg Oncol. 2021; 28: 8729-8739
        • Kim H.J.
        • Noh W.C.
        • Lee E.S.
        • et al.
        Efficacy of neoadjuvant endocrine therapy compared with neoadjuvant chemotherapy in pre-menopausal patients with oestrogen receptor-positive and HER2-negative, lymph node-positive breast cancer.
        Breast Cancer Res. 2020; 22: 54
        • Boughey J.C.
        • Ballman K.V.
        • Hunt K.K.
        • et al.
        Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the american college of surgeons oncology group Z1071 Trial (Alliance).
        J Clin Oncol. 2015; 33: 3386-3393
        • Morency D.
        • Dumitra S.
        • Parvez E.
        • et al.
        Axillary lymph node ultrasound following neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: results from the SN FNAC Study.
        Ann Surg Oncol. 2019; 26: 4337-4345
        • National Comprehensive Cancer Network (NCCN)
        Clinical practice guidelines in oncology. breast cancer (Version 8.2021).
        (Available at:) (Accessed March 15, 2022)
        • Kantor O.
        • Wong S.
        • Weiss A.
        • et al.
        Prognostic significance of residual nodal disease after neoadjuvant endocrine therapy for hormone receptor-positive breast cancer.
        NPJ Breast Cancer. 2020; 6: 35
        • Kantor O.
        • Wakeman M.
        • Weiss A.
        • et al.
        Axillary management after neoadjuvant endocrine therapy for hormone receptor-positive breast cancer.
        Ann Surg Oncol. 2021; 28: 1358-1367
        • Qi P.
        • Yang Y.
        • Bai Q.M.
        • et al.
        Concordance of the 21-gene assay between core needle biopsy and resection specimens in early breast cancer patients.
        Breast Cancer Res Treat. 2021; 186: 327-342
        • Orozco J.I.J.
        • Chang S.C.
        • Matsuba C.
        • et al.
        Is the 21-gene recurrence score on core needle biopsy equivalent to surgical specimen in early-stage breast cancer? A comparison of gene expression between paired core needle biopsy and surgical specimens.
        Ann Surg Oncol. 2021; 28: 5588-5596
        • Bear H.D.
        • Wan W.
        • Robidoux A.
        • et al.
        Using the 21-gene assay from core needle biopsies to choose neoadjuvant therapy for breast cancer: A multicenter trial.
        J Surg Oncol. 2017; 115: 917-923
        • Iwata H.
        • Masuda N.
        • Yamamoto Y.
        • et al.
        Validation of the 21-gene test as a predictor of clinical response to neoadjuvant hormonal therapy for ER+, HER2-negative breast cancer: the TransNEOS study.
        Breast Cancer Res Treat. 2019; 173: 123-133
        • Masuda N.
        • Sagara Y.
        • Kinoshita T.
        • et al.
        Neoadjuvant anastrozole versus tamoxifen in patients receiving goserelin for premenopausal breast cancer (STAGE): a double-blind, randomised phase 3 trial.
        Lancet Oncol. 2012; 13: 345-352
        • Dowsett M.
        • Smith I.E.
        • Ebbs S.R.
        • et al.
        Short-term changes in Ki-67 during neoadjuvant treatment of primary breast cancer with anastrozole or tamoxifen alone or combined correlate with recurrence-free survival.
        Clin Cancer Res. 2005; 11: 951s-8s
        • Ellis M.J.
        • Tao Y.
        • Luo J.
        • et al.
        Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics.
        J Natl Cancer Inst. 2008; 100: 1380-1388