H. Foong1, Y. Cheng1, D. Yakoub1 1University Of Miami,Division Of Surgical Oncology At Department Of Surgery,Miami, FL, USA
Introduction: Current treatment regimens for hormone receptor positive breast cancer patients involve the administration of perioperative chemotherapy or hormonal therapy. However, there are no concluding data as to superiority of one or the other in terms of event free survival.
Methods: Online search of PubMed, Scopus, Embase, Google Scholar was done. Studies comparing neoadjuvant and/or adjuvant chemotherapy to hormonal therapy in both pre and postmenopausal patients with estrogen receptor positive breast cancer were reviewed. Key Bibliographies were reviewed for related articles. Study quality was assessed using STROBE checklist. Pooled odds ratio (OR) along with the 95% confidence intervals (CI) for event free survival at 5 and 9 years were calculated.
Results:A total of 236 studies were identified. Seven met our selection criteria. Total study subjects were 2489 and 2454 for the hormonal therapy and chemotherapy arms respectively. All 7 studies reported on event free survival rates at 5 years, only 4 of them reported on survival rates at 9 years. Meta-analysis of included data showed a trend for better survival in chemotherapy group at 5 years yet this did not reach statistical significance (OR: 1.14; CI: 0.89-1.45). At 9 years, endocrine therapy group seem to have relatively better survival, yet again, the difference did not reach statistical significance (OR: 0.93; CI: 0.78-1.12).
Conclusion:In spite of relatively better survival at 5 years and relatively worse survival at 9 years, there is not enough evidence to claim superiority of perioperative chemotherapy on endocrine therapy in hormone receptor positive pre or post-menopausal breast cancer patients. Further prospective large scale studies are needed to further examine the difference.