Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer
Abstract We investigated whether tailored neoadjuvant therapy (chemotherapy [NCT] or endocrine therapy [NET]) guided by a 70-gene assay could improve breast-conserving surgery (BCS) rates among patients with ER-positive/HER2-negative breast cancer initially deemed ineligible for BCS. Of 130 prospect...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2025-06-01
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| Series: | npj Breast Cancer |
| Online Access: | https://doi.org/10.1038/s41523-025-00772-5 |
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| author | Wonshik Han Eunhye Kang Ji Gwang Jung Hong-Kyu Kim Han-Byoel Lee Jisun Kim Sae Byul Lee Hee-Chul Shin Chan Sub Park Min-Ki Seong Hyun-Ah Kim Eun-Kyu Kim Byung Ho Son |
| author_facet | Wonshik Han Eunhye Kang Ji Gwang Jung Hong-Kyu Kim Han-Byoel Lee Jisun Kim Sae Byul Lee Hee-Chul Shin Chan Sub Park Min-Ki Seong Hyun-Ah Kim Eun-Kyu Kim Byung Ho Son |
| author_sort | Wonshik Han |
| collection | DOAJ |
| description | Abstract We investigated whether tailored neoadjuvant therapy (chemotherapy [NCT] or endocrine therapy [NET]) guided by a 70-gene assay could improve breast-conserving surgery (BCS) rates among patients with ER-positive/HER2-negative breast cancer initially deemed ineligible for BCS. Of 130 prospectively enrolled patients (stage II–IIIA, across four Korean centers), 92 were analyzed. Patients classified as high genomic risk received NCT, while low-risk patients underwent NET (letrozole ± leuprolide for premenopausal women) for 16–24 weeks. The primary endpoint—achieving the surgeon-defined target tumor size for BCS—was reached in 69.6% (95% CI: 59.1–78.7%), significantly surpassing the predefined goal of 50.8% (p < 0.05). The actual overall BCS rate was 59.8% (64.7% NCT, 45.8% NET). Pathologic complete response occurred in 2.2%, exclusively in the NCT group. Thus, pretreatment genomic profiling effectively guided therapy selection, substantially increasing BCS eligibility while sparing low-risk patients unnecessary chemotherapy toxicity. |
| format | Article |
| id | doaj-art-0ce2dcaa5b4349f5b55be8977cb838d6 |
| institution | OA Journals |
| issn | 2374-4677 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Breast Cancer |
| spelling | doaj-art-0ce2dcaa5b4349f5b55be8977cb838d62025-08-20T02:10:32ZengNature Portfolionpj Breast Cancer2374-46772025-06-011111710.1038/s41523-025-00772-5Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancerWonshik Han0Eunhye Kang1Ji Gwang Jung2Hong-Kyu Kim3Han-Byoel Lee4Jisun Kim5Sae Byul Lee6Hee-Chul Shin7Chan Sub Park8Min-Ki Seong9Hyun-Ah Kim10Eun-Kyu Kim11Byung Ho Son12Department of Surgery, Seoul National University Hospital and Seoul National University College of MedicineDepartment of Surgery, Seoul National University Hospital and Seoul National University College of MedicineDepartment of Surgery, Seoul National University Hospital and Seoul National University College of MedicineDepartment of Surgery, Seoul National University Hospital and Seoul National University College of MedicineDepartment of Surgery, Seoul National University Hospital and Seoul National University College of MedicineDivision of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of MedicineDivision of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of MedicineDepartment of Surgery, Seoul National University Bundang HospitalDepartment of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical SciencesDepartment of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical SciencesDepartment of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical SciencesDepartment of Surgery, Seoul National University Bundang HospitalDivision of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of MedicineAbstract We investigated whether tailored neoadjuvant therapy (chemotherapy [NCT] or endocrine therapy [NET]) guided by a 70-gene assay could improve breast-conserving surgery (BCS) rates among patients with ER-positive/HER2-negative breast cancer initially deemed ineligible for BCS. Of 130 prospectively enrolled patients (stage II–IIIA, across four Korean centers), 92 were analyzed. Patients classified as high genomic risk received NCT, while low-risk patients underwent NET (letrozole ± leuprolide for premenopausal women) for 16–24 weeks. The primary endpoint—achieving the surgeon-defined target tumor size for BCS—was reached in 69.6% (95% CI: 59.1–78.7%), significantly surpassing the predefined goal of 50.8% (p < 0.05). The actual overall BCS rate was 59.8% (64.7% NCT, 45.8% NET). Pathologic complete response occurred in 2.2%, exclusively in the NCT group. Thus, pretreatment genomic profiling effectively guided therapy selection, substantially increasing BCS eligibility while sparing low-risk patients unnecessary chemotherapy toxicity.https://doi.org/10.1038/s41523-025-00772-5 |
| spellingShingle | Wonshik Han Eunhye Kang Ji Gwang Jung Hong-Kyu Kim Han-Byoel Lee Jisun Kim Sae Byul Lee Hee-Chul Shin Chan Sub Park Min-Ki Seong Hyun-Ah Kim Eun-Kyu Kim Byung Ho Son Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer npj Breast Cancer |
| title | Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer |
| title_full | Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer |
| title_fullStr | Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer |
| title_full_unstemmed | Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer |
| title_short | Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer |
| title_sort | personalized neoadjuvant strategy using 70 gene assay to increase breast conserving surgery in er her2 breast cancer |
| url | https://doi.org/10.1038/s41523-025-00772-5 |
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