Primary Endocrine Therapy vs Upfront Surgery for Older Women With Estrogen Receptor–Positive Breast Cancer

This systematic review and meta-analysis of more than 22 000 patients with ER-positive breast cancer found no statistically significant survival difference between pET and upfront surgery. Durable disease control under pET seemed to be concentrated in patients with favorable biology. These findings support a framework incorporating tumor biology and frailty, rather than age alone, to identify candidates for pET.

Corresponding Author: Neil Carleton, MD, PhD, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (ncarleton@bwh.harvard.edu).

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