J Cancer 2015; 6(6):575-582. doi:10.7150/jca.11566


Effect of Targeted Agents on the Endocrine Response of Breast Cancer in the Neoadjuvant Setting: A Systematic Review

Antonino Grassadonia1,2✉, Marta Caporale2, Nicola Tinari1,2, Marinella Zilli2, Michele DeTursi1,2, Teresa Gamucci3, Patrizia Vici4, Clara Natoli1,2 on behalf of CINBO (Consorzio Interuniversitario Nazionale per la Bio-Oncologia)

1. Department of Medical, Oral and Biotechnological Sciences, University “G. D'Annunzio”, Chieti, Italy
2. Medical Oncology Unit, “SS. Annunziata” Hospital, Chieti, Italy
3. Department of Oncology, “S.S. Trinita′” Hospital, Sora, Italy
4. Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy

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Grassadonia A, Caporale M, Tinari N, Zilli M, DeTursi M, Gamucci T, Vici P, Natoli C. Effect of Targeted Agents on the Endocrine Response of Breast Cancer in the Neoadjuvant Setting: A Systematic Review. J Cancer 2015; 6(6):575-582. doi:10.7150/jca.11566. Available from http://www.jcancer.org/v06p0575.htm

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Inhibition of aberrantly activated pathways cross-talking with hormone receptor (HR) improves response to endocrine therapy in patients with HR-positive advanced breast cancer. We performed a Pubmed database systematic review to ascertain the existence of a better clinical response when combining endocrine therapy with targeted agents in the neoadjuvant setting. Preclinical studies or trials evaluating toxicity were excluded.

We found nine phase II trials that fulfilled the research criteria. The endocrine agents used were third generation aromatase inhibitors (AIs), anastrozole, letrozole or exemestane. The investigated targeted agents were inhibitors of tyrosine kinase receptors such as gefitinib, imatinib or trastuzumab/lapatinib, inhibitors of mTOR, such as everolimus, inhibitors of COX-2, such as celecoxib, and inhibitors of angiogenesis, such as bevacizumab. The response rate (RR) observed combining endocrine and targeted agents ranged between 36% and 90%.

Overall the studies failed to show a remarkable advantage in RR in the combination group compared to historical control subjects receiving AIs alone.

Keywords: breast cancer, neoadjuvant endocrine therapy, targeted therapy, clinical response