Role of neo-adjuvant hormonal therapy in the treatment of breast cancer: a review of clinical trials

The clinical benefits of endocrine therapy for patients with hormonosensitive breast cancer are well established. For many years, 5 years of tamoxifen was the gold standard of adjuvant treatment. The recent development of new endocrine agents provides physicians with a more effective therapeutic approach. Nevertheless, the success of neoadjuvant endocrine therapy is much more recent and less reported in the literature. This article reviews the studies published about neoadjuvant endocrine treatment (tamoxifen and aromatase inhibitors). According to the literature, neoadjuvant endocrine therapy seems to be effective. In contrast to neoadjuvant chemotherapy, neoadjuvant endocrine therapy is well tolerated, with very few patients having to discontinue the treatment because of side effects. It does not constitute a standard treatment but could have potential for elderly women with operable, hormonosensitive, well differentiated and slowly progressing (SBR I) tumor or for patients with lobular MSBR 1 carcinoma (low chemosensitivity). The newer generation of aromatase inhibitors (letrozole, anastrozole, exemestane) appears to be more active (in terms of overall response rates and conservative surgery rate) than tamoxifen. Patients with an estrogen receptor Allred score of 6 and over are more likely to respond and gain a clinical benefit. The optimal duration of neoadjuvant therapy has not yet been investigated in detail. These preliminary results should be confirmed by further studies

Comparative study of neoadjuvant chemotherapy with and without Zometa for management of locally advanced breast cancer with serum VEGF as primary endpoint: The NEOZOL study

Introduction Neoadjuvant chemotherapy has become the treatment of choice for locally advanced breast cancer. Zoledronic acid (ZA) is a bisphosphonate initially used in the treatment of bone metastases because of its antibone resorption effect. Antitumor effects of ZA, including the inhibition of cell adhesion to mineralized bone or the antiangiogenic effect, have been demonstrated. However, the clinical significance of these effects remains to be determined. Materials and Methods We undertook a multicenter open-label randomized trial to analyze the value of adding ZA to neoadjuvant chemotherapy for TNM clinical stage T2/T3 breast cancer. The primary endpoint was the evolution of serum VEGF. Results The data from 24 patients were included in the ZA group and 26 in the control group. The evolution of serum VEGF was slightly in favor of ZA at 5.5 months (−0.7% vs. +7.5%), without reaching statistical significance (P = .52). The secondary endpoints were the breast conservation rate (higher with ZA; 83.3% vs. 65.4%; P = NS), pathologic complete response (no effect), and circulating tumor cells (odds ratio, 0.68 in favor of ZA; 95% confidence interval, 0.02-24.36). No cases of jaw necrosis or severe renal failure were observed in either group. Conclusion ZA is an antitumor drug of interest because of its multiple effects on tumor biology. Larger trials with longer follow-up that include additional endpoints such as relapse and survival rates would be of interest

CHIMIOTHERAPIE D'INDUCTION DES CANCERS DU SEIN OPERABLES (EXPERIENCE GENERALE DU CENTRE JEAN PERRIN ; ETUDE DES PROTOCOLES FEC100 ET NET)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pronostic et traitement adjuvant des petites tumeurs du sein HER2 positives (revue de la littérature et étude rétrospective à propos de 34 patientes du Centre Jean Perrin)

L'incidence des tumeurs <= 1 cm augmente avec le dépistage organisé par mammographie. La surexpression de HER2 reste un facteur défavorable pour les petites tumeurs avec un risque de rchute à 5 ans de 23% dans la principale étude rétrospective. La question du bénéfice d'un traitement par trastuzumab pour les tumeurs HER2+ <= 1 cm est discutée car ces tumeurs n'ont pas été intégrées dans les études pivotales positionnant le trastuzumab en adjuvant. Nous avons selectionné de façon rétrospective une cohorte de patientes présentant une tumeur <= 1 cm NO HER2+ pour comparer notre pratique et nos résultats aux données de la littérature et étudier les facteurs influençant le risque de rechute. Entre janvier 2002 et décembre 2008, nous avons identifié 34 patientes diagnostiquées et traitées au Centre Jean Perrin pour une tumeur pT1mic, pT1a ou pTb NOMO HER2+. Une analyse descriptive de la population et une analyse univariée des facteurs pronostiques influençant le risque de rechute ont été réalisées. Les tumeurs pT1mic représentaient 21% de l'effectif, les tumeurs pT1a 53% et les tumeurs pT1b 26%. Il n'y avait pas de différence significative dans l'analyse de leurs caractéristiques. Après 2006, 67% des patientes recevaient du trastuzumab associé à une chimiothérapie. Le taux de survie sans récidive à 5 ans était de 87%. Le statut RO- était le seul facteur défavorable influençant la survie sans rechute (p = 0,0035). La taille, le grade SBR, le Ki67 et la multifocalité n'étaient pas retenus comme facteurs pronostiques significatifs. Le nombre de rchute était inférieur pour les patientes qui recevaient du trastuzumab mais non significatifs (p=0,47). Nos données en terme de survie sont comparables aux données de la littérature. Notre étude retrouve l'importance du statut RO-sur le rique de rechure des petites tumeurs HER2+. Le bénéfice d'un traitement par trastuzumab est suggéré mais nos conclusions sont limitées par la faiblesse de notre effectif.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

CHIP et cancers de l’ovaire : pour quelles patientes ?

International audienc

Quality of life for older patients with cancer: a review of the evidence supporting melatonin use

International audienc

Prospective study of the energy balance disruption during adjuvant chemotherapy in post-menopausal early-stage breast cancer patient

International audienc

Effectiveness of a Global Multidisciplinary Supportive and Educational Intervention in Thermal Resort on Anthropometric and Biological Parameters, and the Disease-Free Survival after Breast Cancer Treatment Completion (PACThe)

International audienceA growing knowledge highlights the strong benefit of regular physical activity in the management of breast cancer patients, but few studies have considered biological parameters in their outcomes. In the prospective randomised trial after breast cancer treatment completion "PACThe," we determined the effects of physical activity and nutritional intervention on the biological and anthropometric status of patients after one year of follow-up, and clarified the link between biomarkers at allocation and disease-free survival. 113 patients from the population of the "PACThe" study (n = 251) were analysed for biological parameters. Patients were randomized after chemotherapy in two arms: the intervention "SPA" receiving a 2-week session of physical training, dietary education, and physiotherapy (n = 57), and the control "CTR" (n = 56). Diet questionnaire, anthropometric measures, and blood parameters were determined at allocation and one year later. Survival and recurrence were checked over 7 years. Data were considered as a function of BMI, i.e., ≤25 for normal, 25-30 for overweight, and >30 for obese patients. At allocation, the large standard deviation for nutrient-intake values reflected an unbalanced diet for some patients in the three groups. At one-year follow-up, we noticed an increase in glucose (p 30 groups. Using the Cox model, we demonstrated that the highest testosterone plasma values were linked to an increase of the recurrence risk (HR [CI-95%] = 5.06 [1.66-15.41]; p=0.004). One-year after a global multidisciplinary supportive and educational intervention, we found few anthropometric and biological changes, mainly related to the patient's initial BMI. We highlighted the importance of plasma testosterone in the evaluation of patient's recurrence risk. Future studies would help better understand the mechanisms by which such multidisciplinary interventions could interact with breast cancer recurrence and define the most effective modalities