Leal Frederico, Liutti Vitor Teixeira, Antunes dos Santos Vivian Castro, Novis de Figueiredo Maximiliano Augusto, Macedo Ligia Traldi, Rinck Junior José Augusto, Sasse Andre Deeke
Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Vital Brasil 251, 13083-888 Campinas, Brazil.
Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Vital Brasil 251, 13083-888 Campinas, Brazil.
Breast. 2015 Aug;24(4):406-12. doi: 10.1016/j.breast.2015.03.004. Epub 2015 Apr 7.
The role of neoadjuvant endocrine therapy for resectable breast cancer is not well established, despite encouraging results obtained in the metastatic and adjuvant settings. This systematic review aims to examine existing medical literature on neoadjuvant hormone therapy (HT).
Data from prospective, randomized trials was included if comparing neoadjuvant HT versus surgery alone without adjuvant treatment, or neoadjuvant HT versus chemotherapy (CT), or HT plus CT versus CT alone, or HT plus CT versus HT alone, or two distinct HT. Odds Ratios (OR) were calculated from pooled data.
Five studies compared HT with tamoxifen versus HT with aromatase inhibitors (AI). A meta-analysis of their results demonstrated superiority of AIs in overall response rate (ORR) (OR 1.9; 95% CI 1.17-3.08). Two trials compared HT against CT, and pooled data from them demonstrated a trend favoring CT (OR for ORR 0.75; 95% CI 0.35-1.6). That trend disappeared when only postmenopausal women were considered (OR 1.01; 95% CI 0.62-1.63). One trial compared HT plus CT with no neoadjuvant treatment, and obtained an 83% ORR. One trial compared HT plus CT versus CT alone and found a non-significant increase in ORR for adding HT to CT (OR 1.48; 95% CI 0.58-3.77). No trial compared HT plus CT versus HT alone.
Neoadjuvant HT is a safe and feasible option, but it cannot be considered equivalent to CT. If neoadjuvant HT is performed, AIs are preferable over tamoxifen due to higher response rates.
尽管新辅助内分泌治疗在转移性和辅助性治疗中取得了令人鼓舞的结果，但其在可切除乳腺癌中的作用尚未完全明确。本系统评价旨在研究关于新辅助激素治疗（HT）的现有医学文献。
纳入前瞻性随机试验的数据，这些试验比较了新辅助HT与单纯手术且无辅助治疗、新辅助HT与化疗（CT）、HT加CT与单纯CT、HT加CT与单纯HT，或两种不同的HT。从汇总数据中计算比值比（OR）。
五项研究比较了他莫昔芬HT与芳香化酶抑制剂（AI）HT。对其结果进行的荟萃分析表明，AI在总缓解率（ORR）方面具有优势（OR 1.9；95%CI 1.17 - 3.08）。两项试验比较了HT与CT，汇总数据显示倾向于CT的趋势（ORR的OR为0.75；95%CI 0.35 - 1.6）。当仅考虑绝经后女性时，该趋势消失（OR 1.01；95%CI 0.62 - 1.63）。一项试验比较了HT加CT与无新辅助治疗，获得了83%的ORR。一项试验比较了HT加CT与单纯CT，发现将HT添加到CT中ORR无显著增加（OR 1.48；95%CI 0.58 - 3.77）。没有试验比较HT加CT与单纯HT。
新辅助HT是一种安全可行的选择，但不能认为它等同于CT。如果进行新辅助HT，由于缓解率更高，AI比他莫昔芬更可取。
