We’ve
been interested in neoadjuvant therapy for about 15 years, and we
started doing randomized studies comparing neoadjuvant endocrine
therapy and standard treatment many years ago. The problem is with
relatively small numbers at that time, all we could say is that
doing neoadjuvant endocrine therapy first rather neoadjuvant chemotherapy,
there was no disadvantage.
Our
first study was exclusively in patients with large operable breast
cancers. So the sort of cancers you would consider in younger women
giving neoadjuvant chemotherapy to, but these were women who are
postmenopausal – often older (60s, 70s) – who came with
large tumors who traditionally would have been treated by mastectomy.
But when we did some questionnaires and some investigation, a lot
of the older patients don’t want mastectomy any more than younger
women. It’s almost a myth to believe that, "Oh, she’s
70 so we can treat her by mastectomy, that won’t be a problem."
That’s not what we found. So we looked to try and develop ways,
as in premenopausal women, to avoid mastectomy. And what we found
is when we gave the patients with estrogen receptor-rich, large
operable breast cancers treated with tamoxifen, we found quite significant
response rates and we found that we could reduce the tumor volume
by half in about 60 days.
Primary
chemotherapy or hormonotherapy for patients with breast cancer.
[Review] Brain EG. Misset JL. Rouess J. Primary chemotherapy or hormonotherapy
for patients with breast cancer. [Review] Cancer Treatment Reviews.
25(4):187-97, 1999.
