Even in elderly patients, greater consideration is now being
given to tumor volume reduction in locally advanced breast
cancer, with increased subsequent breast-conserving
surgery. Neoadjuvant endocrine therapy offers the possibility
of testing therapeutic efficacy in vivo, which is of great
importance for optimal adjuvant treatment. Resulting therapy
modifications can be expected to increase disease-free
as well as overall survival. Recent results indicate that remission
rates with primary chemotherapy are significantly
lower in receptor-positive than in receptor-negative breast
cancer and that efficacy parameters in receptor-positive tumors
tend to favor primary endocrine therapy, highlighting
the increased importance of this type of treatment. Aromatase
inhibitors are superior to tamoxifen in terms of clinical
response as well as breast conservation rate. Results
from a small number of studies suggest that prolonged preoperative
aromatase inhibitor therapy for up to 12 months
can increase the rate of clinical and pathological complete
remissions. In conclusion, primary endocrine therapy is a
valid therapeutic option for postmenopausal patients with
locally advanced hormone receptor-positive breast cancer
and significant comorbidity, increased risk of complications
with regard to anesthesia and surgery, desire for breast-conserving
surgery and/or reduced suitability for chemotherapy,
as well as in very old patients.
Copyright / Drug Dosage
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