How we treat HR-positive, HER2-negative early breast cancer

• Published in: Future oncology (London, England) England), 2022-03, Vol.18 (8), p.1003-1022
• Main Authors: Lopez-Tarruella, Sara, Echavarria, Isabel, Jerez, Yolanda, Herrero, Blanca, Gamez, Salvador, Martin, Miguel
• Format: Article
• Language: English
• Subjects: adjuvant; Antineoplastic Combined Chemotherapy Protocols; breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; chemotherapy; Chemotherapy, Adjuvant; Decision Trees; Disease-Free Survival; early stage; endocrine therapy; Female; genomic platforms; HER2-negative; high-risk; HR-positive; Humans; Mastectomy; neoadjuvant; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Receptor, ErbB-2 - metabolism
• ISSN: 1479-6694; 1744-8301
• DOI: 10.2217/fon-2021-0668

The present goal of therapy for early HR+/HER2- breast cancer (BC) is to optimize disease-free survival (DFS) and overall survival (OS) rates with the currently available therapies while avoiding any relevant long-term sequalae. Local therapies have evolved toward less aggressive techniques (i.e. breast-preserving surgery, sentinel lymph node biopsy and intraoperative radiotherapy), which significantly reduce the long-term sequalae observed with more radical treatments. Endocrine therapy (ET) is still the cornerstone of adjuvant treatment because it significantly reduces BC relapse and mortality. Adjuvant chemotherapy is today recommended only for a particular subset of patients with a high risk of recurrence with ET alone, identified through genomic assays, age and/or disease stage. Bisphosphonates reduce the risk of bone metastasis and produce a slight although statistically significant improvement in survival in postmenopausal women. The CDK 4/6 inhibitor abemaciclib has been recently approved by the US FDA for patients at high risk of relapse. The goal of therapy for patients diagnosed with early HR+/HER2- breast cancer (BC) is to maximize survival rates while maintaining the quality of life and avoiding long-term sequalae. Local therapies have evolved toward less aggressive techniques, which significantly reduce the long-term sequalae observed with more radical approaches. Endocrine therapy (ET) remains as the cornerstone of adjuvant treatment because it significantly reduces BC relapse and mortality. Adjuvant chemotherapy is, however, recommended only for a particular subset of patients with a high-risk of recurrence with ET alone, identified through genomic assays together with clinical variables such as age and/or axillary involvement. Additionally, bisphosphonates reduce the risk of bone metastasis with a slight improvement in survival in postmenopausal women. The CDK 4/6 inhibitor abemaciclib has been recently approved by the US FDA for patients at high risk of relapse.