Locally advanced breast cancer is cancer that has spread to the chest wall below or the skin above the breast. Before surgery for locally advanced breast cancer, many women get chemotherapy to weaken and/or destroy the cancer. Chemotherapy given before surgery is called neoadjuvant chemotherapy ("neo" means before and "adjuvant" means in addition to). In some cases, neoadjuvant chemotherapy is given to women diagnosed with early-stage breast cancer (not advanced).
Hormonal therapy medicine (sometimes called endocrine therapy) is often used after surgery for hormone-receptor-positive breast cancer to weaken or destroy any cancer cells that may have been unknowingly left behind during surgery. Hormonal therapy given after surgery is called adjuvant hormonal therapy. Giving hormonal therapy before surgery is less common than giving hormonal therapy after surgery.
Research now suggests that hormonal therapy before surgery may be a good alternative to chemotherapy before surgery for postmenopausal women diagnosed with hormone-receptor-positive breast cancer, including locally advanced breast cancer.
The results were presented at the October 2011 annual meeting of the American Society for Radiation Oncology (ASTRO).
Researchers reviewed the medical records of 145 postmenopausal women diagnosed with hormone-receptor-positive breast cancer; most of the cancers were locally advanced. About 66% of the women got chemotherapy before surgery. The other 33% got hormonal therapy before surgery. The researchers compared the outcomes of the two groups of women. Half the women were followed for more than 4 years and the other half were followed for shorter times.
Progression-free survival -- the proportion of women who were alive with no signs of the cancer growing -- was the same (62.9%) for both groups of women.
Five-year overall survival -- the proportion of women alive 5 years after treatment, whether or not the cancer grew or came back -- also was about the same (79.1%) for both groups of women.
A complete pathologic response -- no signs of cancer at surgery -- was uncommon with either treatment before surgery:
- 5% of the women who got hormonal therapy before surgery had a complete pathologic response.
- Fewer than 10% of the women who got chemotherapy before surgery had a complete pathologic response.
This was a retrospective study, which means that the results were based on treatment plans developed before the study was planned. Doctors are usually more confident in the results of a study where the treatment plans to be compared are part of the study design and randomly assigned to participants (a prospective study). Still, these results suggest that hormonal therapy before surgery could be a good alternative to chemotherapy before surgery for postmenopausal women diagnosed with hormone-receptor-positive breast cancer that's locally advanced. Hormonal therapy -- which includes tamoxifen and the aromatase inhibitors -- can cause bothersome or serious side effects. Still, the side effects of chemotherapy are usually more bothersome or serious.
If you're postmenopausal and have been diagnosed with hormone-receptor-positive breast cancer and some type of treatment before surgery is recommended for you, you may want to ask your doctor about this study and if hormonal therapy before surgery could be a good alternative to chemotherapy before surgery for you.
You can learn more about the hormonal therapy medicines that can be used before and after surgery in the Breastcancer.org Hormonal Therapy section.