Optimal Choice of Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer: Clinical Insights.

Lucas, Mairi W; Kelly, Catherine M

dc.contributor.author	Lucas, Mairi W
dc.contributor.author	Kelly, Catherine M
dc.date.accessioned	2024-05-31T15:28:47Z
dc.date.available	2024-05-31T15:28:47Z
dc.date.issued	2022-08-17
dc.identifier.issn	1179-1322
dc.identifier.pmid	35999966
dc.identifier.doi	10.2147/CMAR.S341466
dc.identifier.uri	http://hdl.handle.net/10147/641731
dc.description	The neoadjuvant setting provides immense opportunities for translational research and drug development. The acceptance of pathological complete response (pCR) as a surrogate endpoint for clinical benefit has led to the widespread use of neoadjuvant treatment. Optimal neoadjuvant therapies are determined based on their ability to achieve the highest rates of pCR. Predicted rates of pCR for triple negative breast cancer (TNBC) treated with sequential taxane/anthracycline regimens range from 35% to 48%. With the addition of a platinum agent pCR rates of 55% are predicted. Further increases have been observed with the addition of immune checkpoint inhibitors to this standard chemotherapy backbone. In the pivotal KEYNOTE-522 clinical trial pCR rates of 65% and 69% were reported for chemotherapy plus pembrolizumab in the overall and PD-L1-positive subgroup respectively. The role of the neoadjuvant chemotherapy is less clear in hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative breast cancer. In general, HR–positive cancers have the least chance of achieving a pCR after neoadjuvant chemotherapy, especially if they are low-grade. If neoadjuvant chemotherapy is given for high-risk HR-positive, HER2-negative breast cancer, standard adjuvant anthracycline/taxane regimens are appropriate. Optimum endocrine therapy is the standard-of-care in the adjuvant setting regardless of pCR. There are several genomic signatures available to guide decisions regarding adjuvant chemotherapy use however these assays are not routinely used in the neoadjuvant setting. For high-risk patients meeting the criteria for the monarchE trial adjuvant abemaciclib in addition to endocrine therapy is associated with an improvement in disease free survival (DFS) at 3 years. Based on the OlympiA trial patients with germline BRCA mutations should be considered for adjuvant olaparib therapy. In this article we review neoadjuvant clinical trials that guide optimum treatment options for TNBC and HR-positive, HER2-negative breast cancer.	en_US
dc.language.iso	en	en_US
dc.rights	© 2022 Lucas and Kelly.
dc.rights	Attribution 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	*
dc.subject	PARP inhibitors	en_US
dc.subject	endocrine therapy	en_US
dc.subject	immune checkpoint inhibitors	en_US
dc.subject	neoadjuvant	en_US
dc.subject	pathological complete response	en_US
dc.subject	platinum agents	en_US
dc.title	Optimal Choice of Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer: Clinical Insights.	en_US
dc.type	Article	en_US
dc.identifier.journal	Cancer management and research	en_US
dc.source.journaltitle	Cancer management and research
dc.source.volume	14
dc.source.beginpage	2493
dc.source.endpage	2506
refterms.dateFOA	2024-05-31T15:28:48Z
dc.source.country	New Zealand