Randomized Phase II Neoadjuvant Comparison Between Letrozole, Anastrozole, and Exemestane for Postmenopausal Women With Estrogen Receptor–Rich Stage 2 to 3 Breast Cancer: Clinical and Biomarker Outcomes and Predictive Value of the Baseline PAM50-Based Intrinsic Subtype—ACOSOG Z1031

DOI Web Site 7 Citations
  • Matthew J. Ellis
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Vera J. Suman
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Jeremy Hoog
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Li Lin
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Jacqueline Snider
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Aleix Prat
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Joel S. Parker
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Jingqin Luo
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Katherine DeSchryver
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • D. Craig Allred
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Laura J. Esserman
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Gary W. Unzeitig
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Julie Margenthaler
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Gildy V. Babiera
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • P. Kelly Marcom
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Joseph M. Guenther
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Mark A. Watson
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Marilyn Leitch
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • Kelly Hunt
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...
  • John A. Olson
    From the Siteman Cancer Center; Washington University, St Louis, MO; American College of Surgeons Oncology Group Statistical Center, Mayo Clinic, Rochester, MN; Linberger Cancer Center, University of North Carolina, Chapel Hill; Duke University Cancer Center, Durham, NC; Helen Diller Cancer Center, University of California San Francisco, San Francisco, CA; Doctors Hospital of Laredo, Laredo; University of Texas MD Anderson Cancer Center, Houston; Simmons Cancer Center, University of Texas Southwestern,...

Description

<jats:sec><jats:title>Purpose</jats:title><jats:p>Preoperative aromatase inhibitor (AI) treatment promotes breast-conserving surgery (BCS) for estrogen receptor (ER) –positive breast cancer. To study this treatment option, responses to three AIs were compared in a randomized phase II neoadjuvant trial designed to select agents for phase III investigations.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>Three hundred seventy-seven postmenopausal women with clinical stage II to III ER-positive (Allred score 6-8) breast cancer were randomly assigned to receive neoadjuvant exemestane, letrozole, or anastrozole. The primary end point was clinical response. Secondary end points included BCS, Ki67 proliferation marker changes, the Preoperative Endocrine Prognostic Index (PEPI), and PAM50-based intrinsic subtype analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>On the basis of clinical response rates, letrozole and anastrozole were selected for further investigation; however, no other differences in surgical outcome, PEPI score, or Ki67 suppression were detected. The BCS rate for mastectomy-only patients at presentation was 51%. PAM50 analysis identified AI-unresponsive nonluminal subtypes (human epidermal growth factor receptor 2 enriched or basal-like) in 3.3% of patients. Clinical response and surgical outcomes were similar in luminal A (LumA) versus luminal B tumors; however, a PEPI of 0 (best prognostic group) was highest in the LumA subset (27.1% v 10.7%; P = .004).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Neoadjuvant AI treatment markedly improved surgical outcomes. Ki67 and PEPI data demonstrated that the three agents tested are biologically equivalent and therefore likely to have similar adjuvant activities. LumA tumors were more likely to have favorable biomarker characteristics after treatment; however, occasional paradoxical increases in Ki67 (12% of tumors with > 5% increase after therapy) suggest treatment-resistant cells, present in some LumA tumors, can be detected by post-treatment profiling.</jats:p></jats:sec>

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