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Neoadjuvant Endocrine — SCE Medical Oncology MCQ

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ModerateBreast CancerNeoadjuvant EndocrineSCE Medical Oncology

A 55-year-old woman with ER+/HER2- breast cancer is offered neoadjuvant endocrine therapy (NET) instead of neoadjuvant chemotherapy. Her tumour is grade 2, strongly ER-positive (Allred 8/8), Ki-67 8%. When is NET preferred over neoadjuvant chemotherapy?

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Correct answer: D — NET is preferred for postmenopausal women with strongly ER-positive

Neoadjuvant endocrine therapy (typically 4-6 months of an aromatase inhibitor) is appropriate for postmenopausal women with ER-strongly-positive, HER2-negative, low-proliferation tumours (Luminal A). Clinical response rates (~50-70%) are comparable to chemotherapy in this subgroup. The POETIC trial assessed Ki-67 response to 2 weeks of AI as a prognostic biomarker. NET avoids chemotherapy toxicity and is particularly useful for elderly/comorbid patients needing tumour downstaging.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer