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ASCO 2025 | Comparing NAET versus NAC in stage II/III ER+/HER2- invasive lobular carcinoma

Jason Mouabbi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses findings from a large retrospective study comparing neoadjuvant endocrine therapy (NAET) and neoadjuvant chemotherapy (NAC) in patients with stage II/III estrogen receptor (ER)-positive, HER2-negative invasive lobular carcinoma. Results showed that neoadjuvant endocrine therapy achieved similar surgical outcomes with notably better long-term distant recurrence-free survival, despite low pathologic complete response rates across both groups. These data suggest that neoadjuvant endocrine therapy may be a more effective and less toxic strategy in managing this distinct breast cancer subtype. This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.

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Transcript

That’s a topic I’m very excited about. To answer this, these are the outcomes of patients before surgery, either giving them chemotherapy, which is a standard of care, or giving them endocrine therapy, which is a hormonal agent. The idea is we know historically lobular cancer does not respond well to chemotherapy. So the idea is can we use an alternative that’s not non-chemo-based, that can give the same outcomes...

That’s a topic I’m very excited about. To answer this, these are the outcomes of patients before surgery, either giving them chemotherapy, which is a standard of care, or giving them endocrine therapy, which is a hormonal agent. The idea is we know historically lobular cancer does not respond well to chemotherapy. So the idea is can we use an alternative that’s not non-chemo-based, that can give the same outcomes. What the study was for. It’s the largest study to look at those outcomes and it proved again that chemotherapy is not ideal for lobular patients with very low response rates to chemotherapy and endocrine therapy gave very encouraging results close to a 10 percent response that is very meaningful called the PEPI score of zero. So that’s very exciting to see and that’s solidify the potential of endocrine therapy to be the next frontier for the treatment of lobular breast cancer before surgery in the neoadjuvant setting as we say.

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