The role of concurrent neoadjuvant endocrine therapy with chemotherapy in HR+HER2- breast cancer remains controversial. This systematic review and meta-analysis was conducted to better assess the efficacy and safety of this strategy in patients with HR+HER2- breast cancer.
The trials in which patients with HR+HER2- breast cancer were randomly assigned to receive neoadjuvant chemotherapy alone or with concurrent endocrine therapy were eligible for inclusion. Prime endpoint was the pathological complete response (pCR) rate. Clinical response (complete clinical response: CR, partial response: PR) and safety were secondary endpoints. A random effects model was used to perform statistical analyses.
A total of 695 patients from five trials were included. PCR rate was 10.34% in concurrent endocrine group and 7.78% in control group (OR=1.40, 95%CI 0.71-2.75, P=0.33). CR rate was 15.65% in concurrent endocrine group and 10.20% in control group (OR=1.66, 95%CI 0.99-2.79, P=0.05). ORR (CR+PR) was significantly higher in concurrent endocrine group than in control group ( 79.42%(274/345) vs. 69.97%(240/343) , OR=1.69, 95%CI 1.19-2.42, P=0.004) and the meta-analysis approach showed no heterogeneity(I2=0%, P=0.54) . Concurrent tamoxifen with chemotherapy could potentially increase the occurrence of adverse events while aromatase inhibitors (AIs) would not.
Our findings provide evidence for the efficacy and safety of concurrent neoadjuvant endocrine therapy (AIs) with chemotherapy as an available option to achieve a higher clinical response rate for HR+HER2- breast cancer patients compared with chemotherapy alone with low toxicity.
The authors.
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