Neoadjuvant endocrine therapy in the treatment of early-stage breast cancer

Abstract

Endocrine therapy is the first targeted biologic therapy to be used in breast cancer treatment and was initially conceived in 1895. Based on the observation that lactation led to a cancer-like ductal epithelial proliferation in cattle and that castration of these cattle led to fatty degeneration of this epithelium, George Thomas Beatson, a Scottish surgeon, hypothesized that bilateral oophorectomy might benefit women with advanced breast cancer. He tested this hypothesis in Glasgow Cancer Hospital on a 33-year-old woman with recurrent soft tissue, axillary, and chest wall disease. Beatson described the case in the Lancet in 1896, reporting significant regression of the patient's cancer after which she survived for another 4 years. Beatson's initial report and subsequent reasoning in a 1901 edition of the Lancet that, "we must look in the female to the ovaries as the seat of the exciting cause of carcinoma, certainly of the mamma.." led to the adoption of oophorectomy for breast cancer. Although oophorectomy was effective in only about a third of women with advanced breast cancer, it became the standard of care for patients with limited adjuvant treatment options. This chapter provides an overview of available endocrine options for neoadjuvant therapy of breast cancer. © 2011 Springer Science + Business Media.