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Purpose of Review <p>The role of neoadjuvant systemic therapy (NST) has evolved with multiple trials demonstrating its ability to downstage tumors. NST can increase breast conservation and decrease morbidity of axillary surgery. Although these benefits are most apparent among patients who undergo neoadjuvant chemotherapy with hormone receptor negative (HR-) or HER2 + tumors, the indications for NST in HR+ HER2- breast cancer are less well-established. This review aims to discuss the role of NST in patients with HR+ HER2- breast cancer.</p> Recent Findings <p>In HR+ HER2- breast cancer, NST increases the rate of breast conservation and can decrease the morbidity of axillary surgery by decreasing the need for axillary lymph node dissection in some patients. Multigene assays can help identify patients that will not derive additional survival benefit from chemotherapy, and Ki67 plays an important role in predicting disease response to NST. There is evolving data supporting the use of neoadjuvant endocrine therapy in postmenopausal HR+ HER2- patients.</p> Summary&#xa0; <p>NST plays an important role in HR+ HER2- breast cancer but needs to be individualized with important consideration to the clinical, pathologic and genomic features of each patient and tumor to optimize both locoregional and systemic therapies.</p>

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Neoadjuvant Systemic Therapy Versus Up-Front Surgery in ER +/PR +/HER2- Breast Cancer

  • 期刊论文

  • 发表日期：

    2025年6月2日

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  • Jamie S. Olapo,
  • Sarah K. Brennan,
  • Sara H. Javid,
  • Meghan R. Flanagan

摘要

Purpose of Review

The role of neoadjuvant systemic therapy (NST) has evolved with multiple trials demonstrating its ability to downstage tumors. NST can increase breast conservation and decrease morbidity of axillary surgery. Although these benefits are most apparent among patients who undergo neoadjuvant chemotherapy with hormone receptor negative (HR-) or HER2 + tumors, the indications for NST in HR+ HER2- breast cancer are less well-established. This review aims to discuss the role of NST in patients with HR+ HER2- breast cancer.

Recent Findings

In HR+ HER2- breast cancer, NST increases the rate of breast conservation and can decrease the morbidity of axillary surgery by decreasing the need for axillary lymph node dissection in some patients. Multigene assays can help identify patients that will not derive additional survival benefit from chemotherapy, and Ki67 plays an important role in predicting disease response to NST. There is evolving data supporting the use of neoadjuvant endocrine therapy in postmenopausal HR+ HER2- patients.

Summary 

NST plays an important role in HR+ HER2- breast cancer but needs to be individualized with important consideration to the clinical, pathologic and genomic features of each patient and tumor to optimize both locoregional and systemic therapies.