Skip to main content

Advertisement

SpringerLink
Log in

The scientific value of preoperative studies and how they can be used

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Preoperative hormonal therapy appears to be an effective option for the treatment of breast cancer and this treatment approach enables breast conservation surgery to be performed instead of mastectomy in patients with large, operable tumors. Short-term preoperative trials are valuable for research of established agents where differential efficacy in biologically distinct subgroups is to be investigated. They can be used to generate hypotheses that can be further examined in suitably powered clinical trials. Longer-term ‘thera-peutic trials’, in which surgery is delayed over a period of months, not only allow for a reduction in tumor size with treatment, but also provide an opportunity to perform a detailed analysis of biomarker expression. Recent advances in hormonal preoperative studies and the increasing importance of prognostic and predictive factors in the management of patients with breast cancer are discussed in this review. Indeed, several clinical studies have been performed in the preoperative setting and it is now apparent that the aromatase inhibitors, such as anastrozole (‘Arimidex’), are valid new treatment options at this stage of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • G Bonadonna U Veronesi C Brambilla L Ferrari A Luini M Greco C Bartoli YG Coopmans de R Zucali F Rilke (1990) ArticleTitlePrimary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more J Natl Cancer Inst 82 1539–1545

    Google Scholar 

  • B Fisher J Bryant N Wolmark E Mamounas A Brown ER Fisher DL Wickerham M Begovic A Cillis ParticleDe A Robidoux RG Margolese AB Cruz JL Hoehn AW Lees NV Dimitrov HD Bear (1998) ArticleTitleEffect of preoperative chemotherapy on the outcome of women with operable breast cancer J Clin Oncol 16 2672–2685

    Google Scholar 

  • WR Miller TJ Anderson RA Hawkins J Keen JM Dixon (1999) Neoadjuvant endocrine treatment: the Edinburgh experience A Howell M Dowsett (Eds) Primary medical therapy for breast cancer: clinical and biological aspects Elsevier Science BV Amsterdam 89–99

    Google Scholar 

  • MJ Ellis A Coop B Singh L Mauriac A Llombert-Cussac F Janicke WR Miller DB Evans M Dugan C Brady E Quebe-Fehling M Borgs (2001) ArticleTitleLetrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial J Clin Oncol 19 3808–3816

    Google Scholar 

  • JF Robertson RI Nicholson NJ Bundred E Anderson Z Rayter M Dowsett JN Fox JM Gee A Webster AE Wakeling C Morris M Dixon (2001) ArticleTitleComparison of the short-term biological effects of 7alpha-[9-(4,4,5,5,5- pentafluoropentylsulfinyl)-nonyl]estra-1,3,5, (10)-triene-3,17beta-diol (Faslodex) versus tamoxifen in postmenopausal women with primary breast cancer Cancer Res 61 6739–6746

    Google Scholar 

  • DJ DeFriend A Howell RI Nicholson E Anderson M Dowsett RE Mansel RW Blamey NJ Bundred JF Robertson C Saunders (1994) ArticleTitleInvestigation of a new pure antiestrogen (ICI 182780) in women with primary breast cancer Cancer Res 54 408–414

    Google Scholar 

  • NJ Bundred E Anderson RI Nicholson M Dowsett M Dixon JF Robertson (2002) ArticleTitleFulvestrant, an estrogen receptor downregulator, reduces cell turnover index more effectively than tamoxifen Anticancer Res 22 2317–2319

    Google Scholar 

  • M Dowsett JM Dixon K Horgan J Salter M Hills E Harvey (2000) ArticleTitleAntiproliferative effects of idoxifene in a placebo-controlled trial in primary human breast cancer Clin Cancer Res 6 2260–2267

    Google Scholar 

  • M Dowsett NJ Bundred A Decensi RC Sainsbury Y Lu MJ Hills FJ Cohen P Veronesi ME O’Brien T Scott DB Muchmore (2001) ArticleTitleEffect of raloxifene on breast cancer cell Ki67 and apoptosis: a double-blind, placebo-controlled, randomized clinical trial in postmenopausal patients Cancer Epidemiol Biomarkers Prev 10 961–966

    Google Scholar 

  • JM Dixon L Renshaw C Bellamy M Stuart G Hoctin-Boes WR Miller (2000) ArticleTitleThe effects of neoadjuvant anastrozole (Arimidex) on tumor volume in postmenopausal women with breast cancer: a randomized, double-blind, single-center study Clin Cancer Res 6 2229–2235

    Google Scholar 

  • W Eiermann S Paepke J Appfelstaedt A Llombart-Cussac J Eremin J Vinholes L Mauriac M Ellis M Lassus HA Chaudri-Ross M Dugan M Borgs (2001) ArticleTitleLetrozole Neo-Adjuvant Breast Cancer Study Group: Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study Ann Oncol 12 1527–1532

    Google Scholar 

  • Smith I, Cataliotti L: Anastrozole versus tamoxifen as neoadjuvant therapy for oestrogen receptor-positive breast cancer in postmenopausal women: the IMPACT and PROACT trials. Eur J Cancer 2(Suppl): 69, 2004 (abstract 47).

    Google Scholar 

  • JC Keen JM Dixon EP Miller DA Cameron U Chetty A Hanby C Bellamy WR Miller (1997) ArticleTitleThe expression of Ki-S1 and BCL-2 and the response to primary tamoxifen therapy in elderly patients with breast cancer Breast Cancer Res Treat 44 123–133

    Google Scholar 

  • DA Cameron JC Keen JM Dixon C Bellamy A Hanby TJ Anderson WR Miller (2000) ArticleTitleEffective tamoxifen therapy of breast cancer involves both antiproliferative and pro-apoptotic changes Eur J Cancer 36 845–851

    Google Scholar 

  • MJ Ellis E Rosen H Dressman J Marks (2003) ArticleTitleNeoadjuvant comparisons of aromatase inhibitors and tamoxifen: pretreatment determinants of response and on-treatment effect J Steroid Biochem Mol Biol 86 301–307

    Google Scholar 

  • A Milla-Santos A Milla N Calvo J Portella L Rallo JM Casanovas M Pons J Rodes (2003) ArticleTitleAnastrozole is an effective neoadjuvant therapy for patients with hormone-dependent, locally advanced breast cancer irrespective of cerbB2 status. Eur J Cancer 1(Suppl) S203

    Google Scholar 

  • InstitutionalAuthorNameThe ATAC Trialists’ Group (2002) ArticleTitleAnastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial Lancet 359 2131–2139

    Google Scholar 

  • InstitutionalAuthorNameThe ATAC Trialists’ Group (2003) ArticleTitleAnastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial efficacy and safety update analyses. Cancer 98 1802–1810

    Google Scholar 

  • Smith I, Dowsett M on behalf of the IMPACT Trialists: Comparison of anastrozole versus tamoxifen alone and in combination as neoadjuvant treatment of estrogen receptor-positive (ER+) operable breast cancer in postmenopausal women: the IMPACT trial. Breast Cancer Res Treat 82(Suppl 1): S6, 2003 (abstract 1).

  • Dowsett M, Smith I on behalf of the IMPACT Trialists: Greater Ki67 response after 2 weeks neoadjuvant treatment with anastrozole than with tamoxifen or anastrozole plus tamoxifen in the IMPACT trial: a potential predictor of relapse-free survival. Breast Cancer Res Treat 82(Suppl 1): S6, 2003 (abstract 2).

  • JC Chang EC Wooten A Tsimelzon SG Hilsenbeck MC Gutierrez R Elledge S Mohsin CK Osborne GC Chamness DC Allred P OConnell (2003) ArticleTitleGene expression profiling for the prediction of therapeutic response to docetaxel in patients with breast cancer Lancet 362 362–369

    Google Scholar 

  • LJ van’t Veer H Dai MJ Vijver Particlevan de YD He AA Hart M Mao HL Peterse K vanderKooy MJ Marton AT Witteveen GJ Schreiber RM Kerkhoven C Roberts PS Linsley R Bernards SH Friend (2002) ArticleTitleGene expression profiling predicts clinical outcome of breast cancer Nature 415 530–536

    Google Scholar 

  • MJ Vijver Particlevan de YD He LJ vantVeer H Dai AA Hart DW Voskuil GJ Schreiber JL Peterse C Roberts MJ Marton M Parrish D Atsma A Witteveen A Glas L Delahaye T vanderVelde H Bartelink S Rodenhuis ET Rutgers SH Friend R Bernards (2002) ArticleTitleA gene-expression signature as a predictor of survival in breast cancer N Engl J Med 347 1999–2009

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Edinburgh Breast Unit, Western General Hospital, EH4 2XU, Edinburgh, EH4 2XU, UK

    J. Michael Dixon

Authors
  1. J. Michael Dixon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Michael Dixon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dixon, J.M. The scientific value of preoperative studies and how they can be used. Breast Cancer Res Treat 87 (Suppl 1), 19–26 (2004). https://doi.org/10.1007/s10549-004-1579-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-004-1579-2

Keywords

Search

Navigation