Breast cancer: an alternative to neoadjuvant chemotherapy for post-menopausal women

For women suffering from breast cancer, the aim of neoadjuvant treatments (i.e. treatments administered before surgery) is to increase the number of patients able to benefit from conservative surgery. In most cases this means chemotherapy, or today, targeted therapies that reduce the size of the tumour enough to make tumorectomy an option, when mastectomy would previously have been required.

Until recently, neoadjuvant treatments based on hormone therapy were available only to women of advanced age or fragile health. Yet these treatments result in fewer side effects than chemotherapy. In addition, more than 2 out of 3 patients develop “hormone-sensitive” forms of breast cancer, meaning that their tumour expresses oestrogen and/or progesterone receptors.

“Although everything seemed to support the use of neoadjuvant hormone therapy for post-menopausal women with primary non-conservable hormone-sensitive breast cancer, studies were still needed to determine the effective response to these treatments, their duration, and the factors predicting their effectiveness,” explains Florence Lerebours, oncologist at Institut Curie (Saint-Cloud) director of the Carmina 02 study. This clinical trial, sponsored by Unicancer, was designed to assess the effectiveness of two hormone therapies—anastrozole and fulvestrant—in neoadjuvant treatment of operable breast cancer among post-menopausal women. It took place between 2007 and 2011 in 6 French hospitals.

Hormone therapy as neoadjuvant treatment

The primary objective of the study was to assess the clinical response to these two treatments. “After 6 months, a clinical response was observed among 52.6% of the patients treated with anastrozole and nearly 37% of those who received fulvestrant,” explains Dr. Emmanuelle Mouret-Fourme, epidemiologist at Institut Curie and co-author of the study. “However, the trial conditions do not allow for comparisons between the two hormone therapies. Conservative surgery was able to be offered to 57.6% of the patients treated with anastrozole and 50% of those treated with fulvestrant.” Finally, the 3-year survival rates of the patients were excellent, at more than 91% regardless of the treatment.

In short, these two hormone therapies proved their effectiveness as a neoadjuvant treatment for operable cancers with positive hormone receptors among post-menopausal women. This would make them an alternative to neoadjuvant chemotherapy. “We encourage women whose breast cancer presents these characteristics to discuss this option with their doctor,” concludes Lerebours.

Find out more

Randomized phase 2 neoadjuvant trial evaluating anastrozole and fulvestrant efficacy for postmenopausal, estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer patients: Results of the UNICANCER CARMINA 02 French trial (UCBG 0609). 

Lerebours F, Rivera S, Mouret-Reynier MA, Alran S, Venat-Bouvet L, Kerbrat P, Salmon R, Becette V, Bourgier C, Cherel P, Boussion V, Balleyguier C, Thibault F, Lavau-Denes S, Nabholz JM, Sigal B, Trassard M, Mathieu MC, Martin AL, Lemonnier J, Mouret-Fourme E.

Cancer. 2016 Jun 17. doi: 10.1002/cncr.30143.