Locally Advanced Breast Cancer (LABC) is a heterogenous disease not amenable for primary surgery. Neoadjuvant therapy has been shown to improve outcomes in patients with inoperable de novo Hormone Receptor-positive/Human Epidermal Growth factor receptor 2-negative (HR+/HER2-) locally advanced breast cancer.
An Italian retrospective single-center study included 23 de novo HR+/HER2-LABC patients, treated with first-line ribociclib plus letrozole. The clinical response was analyzed both at biological and clinical level. At baseline, 15 (65.2%) women had stage IIIA ductal carcinoma; median Ki-67 expression was 15% (range: 10-80%) and 13 patients (56,5%) had Ki-67 under 20%. After treatment, 68.5% of patients achieved overall response with 1 clinical complete response; 73.9% were eligible for surgery. Following surgery, 88% experienced TNM downstaging and 56% obtained Ki-67 regression. At a median follow-up of 18 months, all patients were alive.
Thus, a Cyclin-Dependent Kinase (CDK) 4/6 inhibitor (ribociclib) in combination with a nonsteroidal aromatase inhibitor (letrozole) represents an effective strategy to reduce tumor volume and to facilitate conservative surgery also in those patients initially considered inoperable. To our knowledge, this is the first real-world observational report of ribociclib plus letrozole in this setting.
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