TY - JOUR
T1 - Local-Regional Recurrence After Neoadjuvant Endocrine Therapy
T2 - Data from ACOSOG Z1031 (Alliance), a Randomized Phase 2 Neoadjuvant Comparison Between Letrozole, Anastrozole, and Exemestane for Postmenopausal Women with Estrogen Receptor-Positive Clinical Stage 2 or 3 Breast Cancer
AU - Hunt, Kelly K.
AU - Suman, Vera J.
AU - Wingate, Hannah F.
AU - Leitch, A. Marilyn
AU - Unzeitig, Gary
AU - Boughey, Judy C.
AU - Meric-Bernstam, Funda
AU - Ellis, Matthew J.
AU - Olson, John
N1 - Funding Information:
We thank the clinical trial participants, their families, and all the ACOSOG/Alliance investigators (ClinicalTrials.gov ID Nos. NCT00265759 (ACOSOG-Z1031). The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award Nos. U10CA180821, U10CA180882, and U24CA196171 (to the Alliance for Clinical Trials in Oncology); U10CA180858, U10CA180870, UG1CA232760.
Publisher Copyright:
© 2023, Society of Surgical Oncology.
PY - 2023
Y1 - 2023
N2 - Background: The ACOSOG Z1031 trial addressed the ability of three neoadjuvant aromatase inhibitors (NAIs) to reduce residual disease (cohort A) and to assess whether switching to neoadjuvant chemotherapy (NCT) after 4 weeks of receiving NAI with Ki67 greater than 10% increases pathologic complete response (pCR) in postmenopausal women with estrogen receptor-enriched (Allred score 6–8) breast cancer (BC). Methods: The study enrolled 622 women with clinical stage 2 or 3 estrogen receptor-positive (ER+) BC. Cohort A comprised 377 patients, and cohort B had 245 patients. The analysis cohort consisted of 509 patients after exclusion of patients who did not meet the trial eligibility criteria, switched to NCT or surgery due to 4-week Ki67 greater than 10%, or withdrew before surgery. Distribution of time to local-regional recurrence (LRR) was estimated using the competing-risk approach, in which distant recurrence and second primaries were considered to be competing-risk events. Patients who died without LRR, distant recurrence, or a second primary were censored at the last evaluation. Results: Of the 509 patients, 342 (67.2%) had breast-conserving surgery (BCS). Of 221 patients thought to require mastectomy at presentation, 50% were able to have BCS. Five (1%) patients had no residual disease in the breast or nodes at surgery. Among 382 women alive at this writing, 90% have been followed longer than 5 years. The 5-year cumulative incidence rate for LRR is estimated to be 1.53% (95% confidence interval 0.7–3.0%). Conclusions: Rarely does NAI result in pCR for patients with stage 2 or 3 ER+ BC. However, a significant proportion will have downstaged to allow for BCS. Local-regional recurrence after surgery is uncommon (1.5% at 5 years), supporting the use of BCS after NAI.
AB - Background: The ACOSOG Z1031 trial addressed the ability of three neoadjuvant aromatase inhibitors (NAIs) to reduce residual disease (cohort A) and to assess whether switching to neoadjuvant chemotherapy (NCT) after 4 weeks of receiving NAI with Ki67 greater than 10% increases pathologic complete response (pCR) in postmenopausal women with estrogen receptor-enriched (Allred score 6–8) breast cancer (BC). Methods: The study enrolled 622 women with clinical stage 2 or 3 estrogen receptor-positive (ER+) BC. Cohort A comprised 377 patients, and cohort B had 245 patients. The analysis cohort consisted of 509 patients after exclusion of patients who did not meet the trial eligibility criteria, switched to NCT or surgery due to 4-week Ki67 greater than 10%, or withdrew before surgery. Distribution of time to local-regional recurrence (LRR) was estimated using the competing-risk approach, in which distant recurrence and second primaries were considered to be competing-risk events. Patients who died without LRR, distant recurrence, or a second primary were censored at the last evaluation. Results: Of the 509 patients, 342 (67.2%) had breast-conserving surgery (BCS). Of 221 patients thought to require mastectomy at presentation, 50% were able to have BCS. Five (1%) patients had no residual disease in the breast or nodes at surgery. Among 382 women alive at this writing, 90% have been followed longer than 5 years. The 5-year cumulative incidence rate for LRR is estimated to be 1.53% (95% confidence interval 0.7–3.0%). Conclusions: Rarely does NAI result in pCR for patients with stage 2 or 3 ER+ BC. However, a significant proportion will have downstaged to allow for BCS. Local-regional recurrence after surgery is uncommon (1.5% at 5 years), supporting the use of BCS after NAI.
UR - http://www.scopus.com/inward/record.url?scp=85145289957&partnerID=8YFLogxK
U2 - 10.1245/s10434-022-12972-5
DO - 10.1245/s10434-022-12972-5
M3 - Article
C2 - 36653664
AN - SCOPUS:85145289957
SN - 1068-9265
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
ER -