Lancet-Oncology: Preoperative endocrine therapy and testing can easily predict the risk of breast cancer recurrence

The results showed that in patients with early breast cancer who were positive for hormone-positive, preoperative endocrine therapy was safe, although it did not significantly improve prognostication, but the response of perioperative test patients to endocrine therapy could easily predict the recurrence rate.
this may drive changes in clinical practice.
"This is the largest trial of its kind in the world and provides the strongest evidence to date of the value of providing aromatase inhibitors before breast cancer surgery and simple testing in combination with Ki67 levels," the team said.
" Screenshot Source: Lancet Oncology The trial, called POETIC, is an open, multi-center, random phase 3 clinical trial conducted in 130 hospitals across the UK.
between 2008 and 2014, the trial included 4,480 hormone-positive post menotoral women with early-stage breast cancer.
two-thirds of these patients entered the trial group and received an additional endocrine treatment (intracerine or anatrophic, both aromatase inhibitors) for 2 weeks before and after surgery.
afteroperative complementary treatment was performed in all patients in both the trial and control groups in accordance with local treatment standards, and typically all patients received endocrine therapy for at least 5 years after surgery to reduce the risk of recurrence.
same time, the team also detected changes in cell proliferation index Ki67 in patients through tumor tissue samples at the time of diagnosis and at 2 weeks of preoperative endocrine therapy.
Ki67 can reflect the growth of cancer cells, the test program with MIB1 as the main antibody, the percentage of cancer cells staining positive as ki67 estimate, ≥10% is classified as high expression, otherwise low expression.
, there have been some small trials suggesting that Ki67 is expected to predict a patient's prognostication.
, measuring Ki67 levels is much less expensive and easier to incorporate into clinical practice than other genetic tests that assess treatment responses.
as of February 6, 2018, the medium follow-up time was 62.9 months.
434 (10%) patients had breast cancer recurrence, including 280 (9%) in the trial group and 154 (10%) in the control group, with a similar risk of recurrence over five years in both groups.
did not reduce the risk of recurrence, the team observed that changes in Ki67 were significantly associated with the risk of recurrence in patients receiving endocrine therapy before surgery. Changes in
Ki67 are significantly associated with the risk of recurrence (source: Source: Reference: Table: Medical New View Point) This suggests that the vast majority of patients who receive standard endocrine-assisted therapy after diagnosis with Ki67 low or preoperative endocrine therapy become low, and those who still have a higher risk of recurrence may need further complementary treatment or new experimental therapy after endocrine therapy.
In both groups of patients, the most commonly reported level 3 adverse events were hot water (20 cases in the trial group ( 1% ) vs. 6 cases in the control group ( slt;1%) and musculoskeletal pain (29 cases ( 1% ) vs 13 cases ( 1%).
no treatment-related deaths were reported.
this means that it is safe to receive aromatase inhibitors before surgery.
these findings, the team concluded that preoperative endocrine therapy combined with Ki67 can help determine patient prognostication and guide postoperative complementary therapy. Professor Ian Smith, of Cancer Research UK and co-author of the study, said:
This allows us to determine the most appropriate treatment for each patient after surgery, especially to help some patients avoid the toxic side effects of chemotherapy.
believe it should be part of the standard treatment for early breast cancer.
" References: .1, Ian Smith, et al., (2020). Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomized, phase 3 trial. The Lancet Oncology, DOI: 10.1016/S1470-2045(20)30458-7 [2] Low-cost test could pick out breast cancer patients at increased risk of relapse. Retrieved November 4, 2020, from