Controversial issues of neoadjuvant hormone therapy for early luminal HER2-negative breast cancer in postmenopausal patients

Management of breast cancer remains one of the basic problem of the modern oncology. Many years past experience testifies that the prevalence of pure surgical treatment of breast cancer was unnecessary radical. The used methods caused crippling procedures leading to psychologically grave cosmetic flaws. At present more reasonable trends are emerging towards deescalating the role of the surgeon and escalating the contribution of chemotherapeutic, hormonal and radiation methods of treatment. The present review summarizes the modern data on neoadjuvant hormonal therapy of early breast cancer (BC) particularly of the estrogen positive and Her2-neu negative molecular subtypes. In the group of early breast cancer the patients with locally disseminated, adjusted to the breast and regional lymph nodes, without distant metastases were included. Individual peculiarities of different subclasses of hormonal agent are analyzed: antiestrogens as well as aromatase inhibitors. Successful combined use of the hormones with CDK4/6 inhibitors is discussed. The results of such therapy are exemplified by data of big randomized trials (MONALEESA, MonarchE, PALLAS, PENELOP B). Specific markers are needed for rational choose, application and monitoring of hormonal therapy enabling choosing optimal agent and assessing the effect of treatment. Traditional morphological methods are not too adequate for precise judgment of the pCR after hormonal therapy. A significant aid may provide Ki67 immunohistochemistry, especially comparing basic and post therapeutical levels of expression. The review analyzes also material on the method of risk stratification of the relapses and establishing the prognosis after hormonal therapy.