International Journal of Molecular Sciences (Jul 2024)

Pathological Changes Following Neoadjuvant Endocrine Therapy (NAET): A Multicentre Study of 391 Breast Cancers

  • Islam M. Miligy,
  • Nahla Badr,
  • Andrea Stevens,
  • David Spooner,
  • Rachna Awasthi,
  • Yasmeen Mir,
  • Anuj Khurana,
  • Vijay Sharma,
  • Usha Chandaran,
  • Emad A. Rakha,
  • Yasmine Maurice,
  • Daniel Kearns,
  • Rami Oweis,
  • Amal Asar,
  • Alastair Ironside,
  • Abeer M. Shaaban

DOI
https://doi.org/10.3390/ijms25137381
Journal volume & issue
Vol. 25, no. 13
p. 7381

Abstract

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Oestrogen receptor (ER)-positive breast cancer (BC) is generally well responsive to endocrine therapy. Neoadjuvant endocrine therapy (NAET) is increasingly being used for downstaging ER-positive tumours. This study aims to analyse the effect of NAET on a well-characterised cohort of ER-positive BC with particular emphasis on receptor expression. This is a retrospective United Kingdom (UK) multicentre study of 391 patients who received NAET between October 2012 and October 2020. Detailed analyses of the paired pre- and post-NAET morphological changes and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expression were performed. The median duration of NAET was 86 days, with median survival and overall survival rates of 380 days and 93.4%, respectively. A total of 90.3% of cases achieved a pathological partial response, with a significantly higher rate of response in the HER2-low cancers. Following NAET, BC displayed some pathological changes involving the tumour stroma including central scarring and an increase in tumour infiltrating lymphocytes (TILs) and tumour cell morphology. Significant changes associated with the duration of NAET were observed in tumour grade (30.6% of cases), with downgrading identified in 19.3% of tumours (p p < 0.001). HER2-low breast cancer decreased from 63% to 37% following NAET in the paired samples. Significant morphological and biomarker changes involving PR and HER2 expression occurred following NAET. The findings support biomarker testing on pre-treatment core biopsies and post-treatment residual carcinoma.

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