Ian Smith - CMEcorner.com
Ian Smith - CMEcorner.com
Ian Smith - CMEcorner.com
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Premenopausal Neoadjuvant<br />
Endocrine Therapy for 24 Weeks<br />
Anastrozole + G* v Tamoxifen + G*<br />
100<br />
80<br />
70%<br />
P 0.004<br />
ORR (%)<br />
60<br />
40<br />
51%<br />
*goserelin<br />
20<br />
0<br />
69/98 50/99<br />
A+G<br />
T+G<br />
Masuda N et al Lancet Oncol 2012; 13: 345–52<br />
Why Use Pre-operative Systemic<br />
Therapy<br />
• To downstage to avoid mastectomy<br />
• To prolong survival<br />
• To predict out<strong>com</strong>e in adjuvant trials<br />
• To identify short term molecular markers to<br />
predict long term out<strong>com</strong>e for individual<br />
patients<br />
Neoadjuvant AI v Tamoxifen:<br />
Breast-Conserving Surgery (%)<br />
Letrozole<br />
Anastrozole<br />
50<br />
48%<br />
50<br />
46%<br />
t rate (%)<br />
Improvement<br />
40<br />
30<br />
20<br />
10<br />
36%<br />
t rate (%)<br />
Improvement<br />
40<br />
30<br />
20<br />
10<br />
22%<br />
0<br />
L T<br />
L v T: p=0.03 *<br />
0<br />
A T<br />
A v T: p=0.03 *<br />
Eiermann et al Ann Oncol 2001<br />
IMPACT <strong>Smith</strong> et al JCO 2005
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