Dr. Melisko on the Role of Neoadjuvant Chemotherapy in ER+ Cancer

Michelle E. Melisko, MD, a clinical professor of medicine, University of California, San Francisco (UCSF), discusses the role of neoadjuvant chemotherapy in estrogen receptor (ER)-positive breast cancer.

Neoadjuvant treatment is adventitious for some patients who have large tumors, node-positive tumors, or biologically high-risk cancers.

UCSF conducted a clinical trial, I-SPY, which looked at neoadjuvant chemotherapy in combination with experimental therapies to try to improve the rates of pathologic complete response.

ER-positive diseases rarely achieve a pathologic complete response, so chemotherapy may not be best for this patient population, explains Melisko. Neoadjuvant endocrine therapy, especially in combination with biological therapies such as CDK4/6 inhibitors, may be a better approach for patients who are ER-positive, says Melisko.