[Skip to Content]
[Skip to Content Landing]

Neoadjuvant Endocrine Therapy in Clinical PracticeA Review

Educational Objective
To learn the role of neoadjuvant endocrine therapy (NET) for breast cancer.
1 Credit CME

Importance  In clinical practice, neoadjuvant endocrine therapy (NET) is rarely used despite being an effective treatment modality able to downstage tumors and facilitate breast-conserving surgery.

Observations  Using data from studies conducted since 2000, we provide readers with a critical in-depth review on clinical aspects related to the application of NET in the treatment of hormone receptor (HR)-positive/ERBB2 (formerly HER2)–negative breast cancer. This includes an overview of patient-selection criteria, regimen choice, treatment duration, evaluation of response by imaging, interpretation of pathology after treatment, and surgical considerations. Areas of controversy include the use of gene-expression tests for patient selection, treatment of premenopausal women, surgical management of the axilla after NET, and adjuvant systemic therapy decision-making, including the use of chemotherapy.

Conclusions and Relevance  NET is an optimal treatment modality for a considerable proportion of postmenopausal women diagnosed with HR-positive tumors. The treatment landscape for HR-positive breast cancer is evolving, with novel agents and the growing use of gene expression profiling to define treatment selection. As such, it is likely that NET use will increase and the practical considerations outlined here will become more important.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: February 24, 2021.

Published Online: September 9, 2021. doi:10.1001/jamaoncol.2021.2132

Corresponding Author: Otto Metzger-Filho, MD, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 (otto_metzger@dfci.harvard.edu).

Author Contributions: Dr Metzger-Filho had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Sella and Weiss served as co–first authors and contributed equally to the work.

Concept and design: Sella, Weiss, King, Pilewskie, Metzger-Filho.

Acquisition, analysis, or interpretation of data: Sella, Weiss, Mittendorf, Giuliano.

Drafting of the manuscript: Sella, Weiss, Pilewskie, Metzger-Filho.

Critical revision of the manuscript for important intellectual content: Sella, Weiss, Mittendorf, King, Pilewskie, Giuliano.

Administrative, technical, or material support: Sella, Weiss, Metzger-Filho.

Supervision: Mittendorf, King, Metzger-Filho.

Conflict of Interest Disclosures: Dr Sella reported personal fees from Roche outside the submitted work, is a Goldfarb Advanced Fellow in breast oncology at the Dana-Farber Cancer Institute, and is also supported by the American Physicians Fellowship for Medicine in Israel and the Pinchas Burstein Talpiot Medical Leadership Program. Dr Weiss reported a sponsored research agreement with Myriad Laboratories Inc unrelated to the current work. Dr Mittendorf reported honoraria from Physician Education Resource; personal fees from serving on scientific advisory boards for Exact Sciences (formerly Genomic Health), Merck, and Roche/Genentech; grants from Roche/Genentech via a Stand Up to Cancer grant; funding through a sponsored research agreement from GlaxoSmithKline; uncompensated service on steering committees for Bristol Myers Squibb, Lilly, and Roche/Genentech; and additional support as the Rob and Karen Hale Distinguished Chair in Surgical Oncology. Dr King reported receiving speaker honoraria from and personal fees for serving on the advisory board for Exact Sciences (formerly Genomic Health). Dr Metzger-Filho reported institutional research funding from Pfizer, Roche/Genentech, Abbvie, the Breast Cancer Research Foundation, and the Maor Foundation, as well as funding from serving on the advisory board at GI Therapeutics, outside the submitted work. No other disclosures were reported.

Meeting Presentation: This work was presented at the San Antonio Breast Cancer Symposium; December 10, 2019; San Antonio, Texas.

Morgan  J , Wyld  L , Collins  KA , Reed  MW .  Surgery versus primary endocrine therapy for elderly women with operable primary breast cancer.   Cochrane Database Syst Rev. 2014;(5).Google Scholar
Eiermann  W , Paepke  S , Appfelstaedt  J ,  et al; Letrozole Neo-Adjuvant Breast Cancer Study Group.  Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study.   Ann Oncol. 2001;12(11):1527-1532. doi:10.1023/A:1013128213451 PubMedGoogle ScholarCrossref
Smith  IE , Dowsett  M , Ebbs  SR ,  et al; IMPACT Trialists Group.  Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial.   J Clin Oncol. 2005;23(22):5108-5116. doi:10.1200/JCO.2005.04.005 PubMedGoogle ScholarCrossref
Cataliotti  L , Buzdar  AU , Noguchi  S ,  et al.  Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer: the Pre-Operative “Arimidex” Compared to Tamoxifen (PROACT) trial.   Cancer. 2006;106(10):2095-2103. doi:10.1002/cncr.21872 PubMedGoogle ScholarCrossref
Reinert  T , Gonçalves  R , Ellis  MJ .  Current status of neoadjuvant endocrine therapy in early stage breast cancer.   Curr Treat Options Oncol. 2018;19(5):23. doi:10.1007/s11864-018-0538-9 PubMedGoogle ScholarCrossref
Spring  LM , Gupta  A , Reynolds  KL ,  et al.  Neoadjuvant endocrine therapy for estrogen receptor-positive breast cancer: a systematic review and meta-analysis.   JAMA Oncol. 2016;2(11):1477-1486. doi:10.1001/jamaoncol.2016.1897 PubMedGoogle ScholarCrossref
Semiglazov  VF , Semiglazov  VV , Dashyan  GA ,  et al.  Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer.   Cancer. 2007;110(2):244-254. doi:10.1002/cncr.22789 PubMedGoogle ScholarCrossref
Cardoso  F , Kyriakides  S , Ohno  S ,  et al; ESMO Guidelines Committee.  Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.   Ann Oncol. 2019;30(10):1674. doi:10.1093/annonc/mdz189 PubMedGoogle ScholarCrossref
Gradishar  WJ , Anderson  BO , Abraham  J ,  et al.  Breast cancer, version 3.2020, NCCN Clinical Practice Guidelines in Oncology.   J Natl Compr Canc Netw. 2020;18(4):452-478. doi:10.6004/jnccn.2020.0016 PubMedGoogle ScholarCrossref
Dietz  JR , Moran  MS , Isakoff  SJ ,  et al.  Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. the COVID-19 pandemic breast cancer consortium.   Breast Cancer Res Treat. 2020;181(3):487-497. doi:10.1007/s10549-020-05644-z PubMedGoogle ScholarCrossref
Pariser  AC , Sedghi  T , Soulos  PR , Killelea  B , Gross  CP , Mougalian  SS .  Utilization, duration, and outcomes of neoadjuvant endocrine therapy in the United States.   Breast Cancer Res Treat. 2019;178(2):419-426. doi:10.1007/s10549-019-05397-4 PubMedGoogle ScholarCrossref
Cortazar  P , Zhang  L , Untch  M ,  et al.  Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis.   Lancet. 2014;384(9938):164-172. doi:10.1016/S0140-6736(13)62422-8 PubMedGoogle ScholarCrossref
von Minckwitz  G , Untch  M , Blohmer  J-U ,  et al.  Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes.   J Clin Oncol. 2012;30(15):1796-1804. doi:10.1200/JCO.2011.38.8595 PubMedGoogle ScholarCrossref
Ellis  MJ , Suman  VJ , Hoog  J ,  et al.  Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype—ACOSOG Z1031.   J Clin Oncol. 2011;29(17):2342-2349. doi:10.1200/JCO.2010.31.6950 PubMedGoogle ScholarCrossref
Olson  JA  Jr , Budd  GT , Carey  LA ,  et al.  Improved surgical outcomes for breast cancer patients receiving neoadjuvant aromatase inhibitor therapy: results from a multicenter phase II trial.   J Am Coll Surg. 2009;208(5):906-914. doi:10.1016/j.jamcollsurg.2009.01.035 PubMedGoogle ScholarCrossref
Ellis  MJ , Coop  A , Singh  B ,  et al.  Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial.   J Clin Oncol. 2001;19(18):3808-3816. doi:10.1200/JCO.2001.19.18.3808 PubMedGoogle ScholarCrossref
Ma  CX , Suman  VJ , Leitch  AM ,  et al.  ALTERNATE: Neoadjuvant endocrine treatment (NET) approaches for clinical stage II or III estrogen receptor-positive HER2-negative breast cancer (ER+ HER2- BC) in postmenopausal (PM) women: Alliance A011106.   J Clin Oncol. 2020;38(suppl 15):504. doi:10.1200/JCO.2020.38.15_suppl.504 Google ScholarCrossref
Sparano  JA , Gray  RJ , Makower  DF ,  et al.  Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer.   N Engl J Med. 2018;379(2):111-121. doi:10.1056/NEJMoa1804710 PubMedGoogle ScholarCrossref
Kalinsky  K , Barlow  WE , Meric-Bernstam  F ,  et al. GS3-00. First results from a phase III randomized clinical trial of standard adjuvant endocrine therapy (ET) +/− chemotherapy (CT) in patients (pts) with 1-3 positive nodes, hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) ≤25: SWOG S1007 (RxPonder). Abstract presented at: San Antonio Breast Cancer Symposium; December 10, 2020. Accessed August 5, 2021. https://www.abstractsonline.com/pp8/#!/9223/presentation/2794
Cardoso  F , van’t Veer  LJ , Bogaerts  J ,  et al; MINDACT Investigators.  70-Gene signature as an aid to treatment decisions in early-stage breast cancer.   N Engl J Med. 2016;375(8):717-729. doi:10.1056/NEJMoa1602253 PubMedGoogle ScholarCrossref
Bear  HD , Wan  W , Robidoux  A ,  et al.  Using the 21-gene assay from core needle biopsies to choose neoadjuvant therapy for breast cancer: a multicenter trial.   J Surg Oncol. 2017;115(8):917-923. doi:10.1002/jso.24610 PubMedGoogle ScholarCrossref
Barker  AD , Sigman  CC , Kelloff  GJ , Hylton  NM , Berry  DA , Esserman  LJ .  I-SPY 2: an adaptive breast cancer trial design in the setting of neoadjuvant chemotherapy.   Clin Pharmacol Ther. 2009;86(1):97-100. doi:10.1038/clpt.2009.68 PubMedGoogle ScholarCrossref
Gianni  L , Zambetti  M , Clark  K ,  et al.  Gene expression profiles in paraffin-embedded core biopsy tissue predict response to chemotherapy in women with locally advanced breast cancer.   J Clin Oncol. 2005;23(29):7265-7277. doi:10.1200/JCO.2005.02.0818 PubMedGoogle ScholarCrossref
Whitworth  P , Beitsch  P , Mislowsky  A ,  et al.  Chemosensitivity and endocrine sensitivity in clinical luminal breast cancer patients in the prospective Neoadjuvant Breast Registry Symphony trial (NBRST) predicted by molecular subtyping.   Ann Surg Oncol. 2017;24(3):669-675. doi:10.1245/s10434-016-5600-x PubMedGoogle ScholarCrossref
Ueno  T , Masuda  N , Yamanaka  T ,  et al.  Evaluating the 21-gene assay Recurrence Score® as a predictor of clinical response to 24 weeks of neoadjuvant exemestane in estrogen receptor-positive breast cancer.   Int J Clin Oncol. 2014;19(4):607-613. doi:10.1007/s10147-013-0614-x PubMedGoogle ScholarCrossref
Akashi-Tanaka  S , Shimizu  C , Ando  M ,  et al.  21-Gene expression profile assay on core needle biopsies predicts responses to neoadjuvant endocrine therapy in breast cancer patients.   Breast. 2009;18(3):171-174. doi:10.1016/j.breast.2009.03.005 PubMedGoogle ScholarCrossref
Iwata  H , Masuda  N , Yamamoto  Y ,  et al.  Validation of the 21-gene test as a predictor of clinical response to neoadjuvant hormonal therapy for ER+, HER2-negative breast cancer: the TransNEOS study.   Breast Cancer Res Treat. 2019;173(1):123-133. doi:10.1007/s10549-018-4964-y PubMedGoogle ScholarCrossref
Prat  A , Lluch  A , Turnbull  AK ,  et al.  A PAM50-based chemoendocrine score for hormone receptor-positive breast cancer with an intermediate risk of relapse.   Clin Cancer Res. 2017;23(12):3035-3044. doi:10.1158/1078-0432.CCR-16-2092 PubMedGoogle ScholarCrossref
Gazet  J-C , Coombes  RC , Ford  HT ,  et al.  Assessment of the effect of pretreatment with neoadjuvant therapy on primary breast cancer.   Br J Cancer. 1996;73(6):758-762. doi:10.1038/bjc.1996.132 PubMedGoogle ScholarCrossref
Torrisi  R , Bagnardi  V , Pruneri  G ,  et al.  Antitumour and biological effects of letrozole and GnRH analogue as primary therapy in premenopausal women with ER and PgR positive locally advanced operable breast cancer.   Br J Cancer. 2007;97(6):802-808. doi:10.1038/sj.bjc.6603947 PubMedGoogle ScholarCrossref
Shimizu  D , Ishikawa  T , Tanabe  M ,  et al.  Preoperative endocrine therapy with goserelin acetate and tamoxifen in hormone receptor-positive premenopausal breast cancer patients.   Breast Cancer. 2014;21(5):557-562. doi:10.1007/s12282-012-0429-z PubMedGoogle ScholarCrossref
Masuda  N , Sagara  Y , Kinoshita  T ,  et al.  Neoadjuvant anastrozole versus tamoxifen in patients receiving goserelin for premenopausal breast cancer (STAGE): a double-blind, randomised phase 3 trial.   Lancet Oncol. 2012;13(4):345-352. doi:10.1016/S1470-2045(11)70373-4 PubMedGoogle ScholarCrossref
Alba  E , Calvo  L , Albanell  J ,  et al; GEICAM.  Chemotherapy (CT) and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from the GEICAM/2006-03, a multicenter, randomized, phase-II study.   Ann Oncol. 2012;23(12):3069-3074. doi:10.1093/annonc/mds132 PubMedGoogle ScholarCrossref
Kim  HJ , Noh  WC , Lee  ES ,  et al.  Efficacy of neoadjuvant endocrine therapy compared with neoadjuvant chemotherapy in pre-menopausal patients with oestrogen receptor-positive and HER2-negative, lymph node-positive breast cancer.   Breast Cancer Res. 2020;22(1):54. doi:10.1186/s13058-020-01288-5 PubMedGoogle ScholarCrossref
Dellapasqua  S , Gray  KP , Munzone  E ,  et al; International Breast Cancer Study Group.  Neoadjuvant degarelix versus triptorelin in premenopausal patients who receive letrozole for locally advanced endocrine-responsive breast cancer: a randomized phase II trial.   J Clin Oncol. 2019;37(5):386-395. doi:10.1200/JCO.18.00296 PubMedGoogle ScholarCrossref
Llombart-Cussac  A , Guerrero  Á , Galán  A ,  et al.  Phase II trial with letrozole to maximum response as primary systemic therapy in postmenopausal patients with ER/PgR[+] operable breast cancer.   Clin Transl Oncol. 2012;14(2):125-131. doi:10.1007/s12094-012-0771-9 PubMedGoogle ScholarCrossref
Carpenter  R , Doughty  JC , Cordiner  C ,  et al.  Optimum duration of neoadjuvant letrozole to permit breast conserving surgery.   Breast Cancer Res Treat. 2014;144(3):569-576. doi:10.1007/s10549-014-2835-8 PubMedGoogle ScholarCrossref
Mlineritsch  B , Tausch  C , Singer  C ,  et al; Austrian Breast, Colorectal Cancer Study Group (ABCSG).  Exemestane as primary systemic treatment for hormone receptor positive post-menopausal breast cancer patients: a phase II trial of the Austrian Breast and Colorectal Cancer Study Group (ABCSG-17).   Breast Cancer Res Treat. 2008;112(1):203-213. doi:10.1007/s10549-007-9843-x PubMedGoogle ScholarCrossref
Barnadas  A , Gil  M , González  S ,  et al.  Exemestane as primary treatment of oestrogen receptor-positive breast cancer in postmenopausal women: a phase II trial.   Br J Cancer. 2009;100(3):442-449. doi:10.1038/sj.bjc.6604868 PubMedGoogle ScholarCrossref
Baselga  J , Semiglazov  V , van Dam  P ,  et al.  Phase II randomized study of neoadjuvant everolimus plus letrozole compared with placebo plus letrozole in patients with estrogen receptor-positive breast cancer.   J Clin Oncol. 2009;27(16):2630-2637. doi:10.1200/JCO.2008.18.8391 PubMedGoogle ScholarCrossref
Fasching  PA , Jud  SM , Hauschild  M ,  et al.  FemZone trial: a randomized phase II trial comparing neoadjuvant letrozole and zoledronic acid with letrozole in primary breast cancer patients.   BMC Cancer. 2014;14:66. doi:10.1186/1471-2407-14-66 PubMedGoogle ScholarCrossref
Fontein  DBY , Charehbili  A , Nortier  JWR ,  et al.  Efficacy of six month neoadjuvant endocrine therapy in postmenopausal, hormone receptor-positive breast cancer patients—a phase II trial.   Eur J Cancer. 2014;50(13):2190-2200. doi:10.1016/j.ejca.2014.05.010 PubMedGoogle ScholarCrossref
Guarneri  V , Generali  DG , Frassoldati  A ,  et al.  Double-blind, placebo-controlled, multicenter, randomized, phase IIb neoadjuvant study of letrozole-lapatinib in postmenopausal hormone receptor-positive, human epidermal growth factor receptor 2-negative, operable breast cancer.   J Clin Oncol. 2014;32(10):1050-1057. doi:10.1200/JCO.2013.51.4737 PubMedGoogle ScholarCrossref
Lerebours  F , Rivera  S , Mouret-Reynier  M-A ,  et al.  Randomized phase 2 neoadjuvant trial evaluating anastrozole and fulvestrant efficacy for postmenopausal, estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer patients: results of the UNICANCER CARMINA 02 French trial (UCBG 0609).   Cancer. 2016;122(19):3032-3040. doi:10.1002/cncr.30143 PubMedGoogle ScholarCrossref
Johnston  S , Puhalla  S , Wheatley  D ,  et al.  Randomized phase II study evaluating palbociclib in addition to letrozole as neoadjuvant therapy in estrogen receptor-positive early breast cancer: PALLET trial.   J Clin Oncol. 2019;37(3):178-189. doi:10.1200/JCO.18.01624 PubMedGoogle ScholarCrossref
Skriver  SK , Laenkholm  A-V , Rasmussen  BB ,  et al.  Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG).   Acta Oncol. 2018;57(1):31-37. doi:10.1080/0284186X.2017.1401228 PubMedGoogle ScholarCrossref
Mayer  IA , Prat  A , Egle  D ,  et al.  A phase II randomized study of neoadjuvant letrozole plus alpelisib for hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer (NEO-ORB).   Clin Cancer Res. 2019;25(10):2975-2987. doi:10.1158/1078-0432.CCR-18-3160 PubMedGoogle ScholarCrossref
Saura  C , Hlauschek  D , Oliveira  M ,  et al.  Neoadjuvant letrozole plus taselisib versus letrozole plus placebo in postmenopausal women with oestrogen receptor-positive, HER2-negative, early-stage breast cancer (LORELEI): a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial.   Lancet Oncol. 2019;20(9):1226-1238. doi:10.1016/S1470-2045(19)30334-1 PubMedGoogle ScholarCrossref
Ellis  MJ , Tao  Y , Luo  J ,  et al.  Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics.   J Natl Cancer Inst. 2008;100(19):1380-1388. doi:10.1093/jnci/djn309 PubMedGoogle ScholarCrossref
Ueno  T , Saji  S , Masuda  N ,  et al.  Changes in Recurrence Score by neoadjuvant endocrine therapy of breast cancer and their prognostic implication.   ESMO Open. 2019;4(1):e000476. doi:10.1136/esmoopen-2018-000476 PubMedGoogle Scholar
Preusser  M , De Mattos-Arruda  L , Thill  M ,  et al.  CDK4/6 inhibitors in the treatment of patients with breast cancer: summary of a multidisciplinary round-table discussion.   ESMO Open. 2018;3(5):e000368. doi:10.1136/esmoopen-2018-000368 PubMedGoogle Scholar
Prat  A , Saura  C , Pascual  T ,  et al.  Ribociclib plus letrozole versus chemotherapy for postmenopausal women with hormone receptor-positive, HER2-negative, luminal B breast cancer (CORALLEEN): an open-label, multicentre, randomised, phase 2 trial.   Lancet Oncol. 2020;21(1):33-43. doi:10.1016/S1470-2045(19)30786-7 PubMedGoogle ScholarCrossref
Chow  LWC , Morita  S , Chow  CYC , Ng  W-K , Toi  M .  Neoadjuvant palbociclib on ER+ breast cancer (N007): clinical response and EndoPredict’s value.   Endocr Relat Cancer. 2018;25(2):123-130. doi:10.1530/ERC-17-0396 PubMedGoogle ScholarCrossref
Ma  CX , Gao  F , Luo  J ,  et al.  NeoPalAna: neoadjuvant palbociclib, a cyclin-dependent kinase 4/6 inhibitor, and anastrozole for clinical stage 2 or 3 estrogen receptor-positive breast cancer.   Clin Cancer Res. 2017;23(15):4055-4065. doi:10.1158/1078-0432.CCR-16-3206 PubMedGoogle ScholarCrossref
Hurvitz  SA , Martin  M , Press  MF ,  et al.  Potent cell-cycle inhibition and upregulation of immune response with abemaciclib and anastrozole in neoMONARCH, phase II neoadjuvant study in HR+/HER2- breast cancer.   Clin Cancer Res. 2020;26(3):566-580. doi:10.1158/1078-0432.CCR-19-1425 PubMedGoogle ScholarCrossref
Cottu  P , D’Hondt  V , Dureau  S ,  et al.  Letrozole and palbociclib versus chemotherapy as neoadjuvant therapy of high-risk luminal breast cancer.   Ann Oncol. 2018;29(12):2334-2340. doi:10.1093/annonc/mdy448 PubMedGoogle ScholarCrossref
Khan  QJ , O’Dea  A , Bardia  A ,  et al.  Letrozole + ribociclib versus letrozole + placebo as neoadjuvant therapy for ER+ breast cancer (FELINE trial).   J Clin Oncol. 2020;38(suppl 15):505. doi:10.1200/JCO.2020.38.15_suppl.505 Google ScholarCrossref
Yeh  E , Slanetz  P , Kopans  DB ,  et al.  Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer.   AJR Am J Roentgenol. 2005;184(3):868-877. doi:10.2214/ajr.184.3.01840868 PubMedGoogle ScholarCrossref
Takeda  K , Kanao  S , Okada  T ,  et al.  MRI evaluation of residual tumor size after neoadjuvant endocrine therapy vs. neoadjuvant chemotherapy.   Eur J Radiol. 2012;81(9):2148-2153. doi:10.1016/j.ejrad.2011.05.013 PubMedGoogle ScholarCrossref
Hieken  TJ , Boughey  JC , Jones  KN , Shah  SS , Glazebrook  KN .  Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer.   Ann Surg Oncol. 2013;20(10):3199-3204. doi:10.1245/s10434-013-3118-z PubMedGoogle ScholarCrossref
Palmieri  C , Cleator  S , Kilburn  LS ,  et al.  NEOCENT: a randomised feasibility and translational study comparing neoadjuvant endocrine therapy with chemotherapy in ER-rich postmenopausal primary breast cancer.   Breast Cancer Res Treat. 2014;148(3):581-590. doi:10.1007/s10549-014-3183-4 PubMedGoogle ScholarCrossref
Montagna  G , Sevilimedu  V , Fornier  M , Jhaveri  K , Morrow  M , Pilewskie  ML .  How effective is neoadjuvant endocrine therapy (NET) in downstaging the axilla and achieving breast-conserving surgery?   Ann Surg Oncol. 2020;27(12):4702-4710. doi:10.1245/s10434-020-08888-7 PubMedGoogle ScholarCrossref
Weiss  A , Wong  S , Golshan  M ,  et al.  Patterns of axillary management in stages 2 and 3 hormone receptor-positive breast cancer by initial treatment approach.   Ann Surg Oncol. 2019;26(13):4326-4336. doi:10.1245/s10434-019-07785-y PubMedGoogle ScholarCrossref
Symmans  WF , Wei  C , Gould  R ,  et al.  Long-term prognostic risk after neoadjuvant chemotherapy associated with residual cancer burden and breast cancer subtype.   J Clin Oncol. 2017;35(10):1049-1060. doi:10.1200/JCO.2015.63.1010 PubMedGoogle ScholarCrossref
Symmans  WF , Peintinger  F , Hatzis  C ,  et al.  Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy.   J Clin Oncol. 2007;25(28):4414-4422. doi:10.1200/JCO.2007.10.6823 PubMedGoogle ScholarCrossref
Smith  I , Robertson  J , Kilburn  L ,  et al.  Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial.   Lancet Oncol. 2020;21(11):1443-1454. doi:10.1016/S1470-2045(20)30458-7 PubMedGoogle ScholarCrossref
Dowsett  M , Smith  IE , Ebbs  SR ,  et al; IMPACT Trialists Group.  Prognostic value of Ki67 expression after short-term presurgical endocrine therapy for primary breast cancer.   J Natl Cancer Inst. 2007;99(2):167-170. doi:10.1093/jnci/djk020 PubMedGoogle ScholarCrossref
Ellis  MJ , Suman  VJ , Hoog  J ,  et al.  Ki67 proliferation index as a tool for chemotherapy decisions during and after neoadjuvant aromatase inhibitor treatment of breast cancer: results from the American College of Surgeons Oncology Group Z1031 Trial (Alliance).   J Clin Oncol. 2017;35(10):1061-1069. doi:10.1200/JCO.2016.69.4406 PubMedGoogle ScholarCrossref
Dowsett  M , Ellis  MJ , Dixon  JM ,  et al.  Evidence-based guidelines for managing patients with primary ER+ HER2- breast cancer deferred from surgery due to the COVID-19 pandemic.   NPJ Breast Cancer. 2020;6:21. doi:10.1038/s41523-020-0168-9 PubMedGoogle ScholarCrossref
Harris  LN , Ismaila  N , McShane  LM ,  et al; American Society of Clinical Oncology.  Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline.   J Clin Oncol. 2016;34(10):1134-1150. doi:10.1200/JCO.2015.65.2289 PubMedGoogle ScholarCrossref
Turnbull  AK , Arthur  LM , Renshaw  L ,  et al.  Accurate prediction and validation of response to endocrine therapy in breast cancer.   J Clin Oncol. 2015;33(20):2270-2278. doi:10.1200/JCO.2014.57.8963 PubMedGoogle ScholarCrossref
Kantor  O , Wakeman  M , Weiss  A ,  et al.  Axillary management after neoadjuvant endocrine therapy for hormone receptor–positive breast cancer.   Ann Surg Oncol. 2021;28(3):1358-1367. doi:10.1245/s10434-020-09073-6 PubMedGoogle ScholarCrossref
Giuliano  AE , Hunt  KK , Ballman  KV ,  et al.  Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.   JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90 PubMedGoogle ScholarCrossref
Harbeck  N , Gluz  O , Kuemmel  S ,  et al. Abstract GS4-04:Endocrine therapy alone in patients with intermediate or high-risk luminal early breast cancer (0-3 lymph nodes), Recurrence Score <26 and Ki67 response after preoperative endocrine therapy: primary outcome analysis from the WSG-ADAPT HR+/HER2- trial. Abstract presented at: San Antonio Breast Cancer Symposium; December 11, 2020. Accessed August 5, 2021. https://cancerres.aacrjournals.org/content/81/4_Supplement/GS4-04
Johnston  SRD , Harbeck  N , Hegg  R ,  et al; monarchE Committee Members and Investigators.  Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2-, node-positive, high-risk, early breast cancer (monarchE).   J Clin Oncol. 2020;38(34):3987-3998. doi:10.1200/JCO.20.02514 PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.