Short-term outcomes of neoadjuvant hormonal therapy versus neoadjuvant chemotherapy in breast cancer: systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Introduction: Estrogen receptor positive (ER⁺) breast cancer (BC) is highly hormonal therapy-responsive. The choice between neoadjuvant hormonal therapy (NHT) and neoadjuvant chemotherapy (NCT) remains controversial. The aim of this meta-analysis was to evaluate benefits and safety of NHT compared with NCT for operable BC patients.

Areas covered: Electronic databases were searched to identify randomized clinical trials (RCTs) comparing NHT and NCT for treatment of invasive and immunohistochemically ER⁺ BC. Major outcomes were clinical response rate, pathologic complete response (pCR), operation methods, recurrence, and adverse events. Five RCTs were included. The clinical response rates between NHT and NCT were not statistically different overall, or in ER-rich patients or postmenopausal women. Compared with NCT, NHT had a significant reduction of complete response rate and an increment in progressive disease rate. NHT increased rates of breast conserving surgery (BCS) and wide local excision (WLE) compared with NCT. All the other parameters were comparable. Patients receiving NHT had better tolerance than those undergoing NCT.

Expert commentary: When treating BC, NHT was well tolerated, and contributed to more BCS and WLE cases, especially in ER-rich postmenopausal patients. While for those who are eligible for chemotherapy, NCT might be better recommended due to higher response rates.

KEYWORDS:

• Breast cancer
• estrogen receptor
• meta-analysis
• neoadjuvant chemotherapy
• neoadjuvant hormonal therapy
• randomized controlled trial

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [no.: 81572350]. The funder had no role in the study design, the collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication.