Neoadjuvant Endocrine Therapy for Locally Advanced Breast Cancer
Posted: Wednesday, July 8, 2020
Recent data presented during the ASCO20 Virtual Scientific Program from the ALTERNATE trial (Abstract 504) concluded that neither fulvestrant nor fulvestrant plus anastrozole significantly improved the endocrine-sensitive disease rate compared with anastrozole alone in patients with locally advanced estrogen receptor–positive HER2-negative breast cancer. According to Cynthia X. Wa, MD, PhD, of Washington University School of Medicine, St. Louis, and colleagues, however, recurrence-free survival data from the study are still awaited.
The study was conducted to determine whether neoadjuvant endocrine therapy with fulvestrant or the combination of anastrozole and fulvestrant is better than anastrozole alone. In total, 1,362 patients were enrolled in the trial, with 1,299 patients receiving treatment: fulvestrant (n = 431), anastrozole (n = 434), or both (n = 434). Nearly three-quarters of study patients were considered candidates for breast-conservation surgery.
The endocrine-sensitive disease rate was 18.6% in patients receiving anastrozole, 22.7% in patients receiving fulvestrant, and 20.5% in patients receiving both; no significant difference in these rates was found between anastrozole and fulvestrant (P = .15) or anastrozole and both (P = .55). Among the 825 patients who who had a Ki67 index of less than 10% at week 4 and completed neoadjuvant endocrine therapy plus surgery, the endocrine-sensitive disease and breast-conservation surgery rates were 27.7% and 70.3% with anastrozole, 29.6% and 68.1% with fulvestrant, and 26.8% and 69.9% with both, respectively.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
