Time for a shift in molecular down staging in luminal breast cancer
Mené en Espagne sur 106 patientes atteintes d'un cancer du sein de type luminal B, HR+ HER2- après la ménopause, cet essai de phase II compare l'efficacité, du point de vue de la proportion de patientes présentant un faible risque de récidive au moment du traitement chirurgical, et la toxicité d'un traitement néoadjuvant combinant ribociclib et létrozole et une chimiothérapie à base de doxorubicine, cyclophosphamide et paclitaxel (durée médiane de suivi : 200 jours)
The management of locally advanced breast cancer and, in some cases, operable node-positive disease, includes neoadjuvant chemotherapy (with or without HER2-targeted therapies), surgery, and locoregional radiotherapy. Pathological complete response to neoadjuvant therapy is considered an important prognostic factor in locally advanced breast cancer, but such prognostic information is primarily relevant in triple-negative breast cancer and HER2-positive subtypes. In luminal breast cancer, systemic chemotherapy can result in clinical downstaging or clinical response, but pathological complete response is not reached in most cases making the use of this endpoint of questionable value in this subtype. Data from various studies have suggested the value of neoadjuvant endocrine therapy in the ability to achieve a measurable clinical response that is even more pronounced when endocrine agents are combined with a biological agent. Several biomarkers have been investigated in such studies, primarily proliferation markers such as Ki67, suggesting an early effect of neoadjuvant endocrine therapy. Few studies have compared chemotherapy to combination endocrine therapy with regards to the effects of clinical efficacy and biomarkers in patients with luminal breast cancer.
The Lancet Oncology 2019