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. 2024 Jun:75:103726.
doi: 10.1016/j.breast.2024.103726. Epub 2024 Apr 5.

Radiological, pathological and surgical outcomes after neoadjuvant endocrine treatment in patients with ER-positive/HER2-negative breast cancer with a clinical high risk and a low-risk 70-gene signature

Josefien P van Olmen  1 , Chaja F Jacobs  2 , Sanne A L Bartels  1 , Claudette E Loo  3 , Joyce Sanders  4 , Marie-Jeanne T F D Vrancken Peeters  1 , Caroline A Drukker  1 , Frederieke H van Duijnhoven  1 , Marleen Kok  5
Affiliations

Radiological, pathological and surgical outcomes after neoadjuvant endocrine treatment in patients with ER-positive/HER2-negative breast cancer with a clinical high risk and a low-risk 70-gene signature

Josefien P van Olmen et al. Breast. 2024 Jun.

Abstract

Objective: This study aims to evaluate the response to and surgical benefits of neoadjuvant endocrine therapy (NET) in ER+/HER2-breast cancer patients who are clinically high risk, but genomic low risk according to the 70-gene signature (MammaPrint).

Methods: Patients with ER+/HER2-invasive breast cancer with a clinical high risk according to MINDACT, who had a genomic low risk according to the 70-gene signature and were treated with NET between 2015 and 2023 in our center, were retrospectively analyzed. RECIST 1.1 criteria were used to assess radiological response using MRI or ultrasound. Surgical specimens were evaluated to assess pathological response. Two breast cancer surgeons independently scored the eligibility of breast conserving therapy (BCS) pre- and post- NET.

Results: Of 72 included patients, 23 were premenopausal (100% started with tamoxifen of which 4 also received OFS) and 49 were postmenopausal (98% started with an aromatase inhibitor). Overall, 8 (11%) showed radiological complete response. Only 1 (1.4%) patient had a pathological complete response (RCB-0) and 68 (94.4%) had a pathological partial response (RCB-1 or RCB-2). Among the 26 patients initially considered for mastectomy, 14 (53.8%) underwent successful BCS. In all 20 clinical node-positive patients, a marked axillary lymph node was removed to assess response. Four out of 20 (20%) patients had a pathological complete response of the axilla.

Conclusion: The study showed that a subgroup of patients with a clinical high risk and a genomic low risk ER+/HER2-breast cancer benefits from NET resulting in BCS instead of a mastectomy. Additionally, NET may enable de-escalation in axillary treatment.

Keywords: 70-Gene signature; ER+/HER2-breast cancer; Endocrine therapy; Neoadjuvant treatment.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J.P.O., C.F.J., S.A.L.B., C.E.L., J.S., M.T.F.D.V., C.A.D., F.H.D. declare no competing financial or non-financial interests. M.K. reports research funding paid to the institute from BMS, Roche and AstraZeneca and an advisory for AstraZeneca, Daiichi Sankyo, Domain Therapeutics, Alderaan, BMS, MSD and Roche.

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