Neoadjuvant therapy has four goals in breast cancer: decrease tumor volume to operate tumors that initially were inoperable,
increase the number of conservative surgeries, evaluate the chemosensitivity in vivo and analyze the management of micrometastases.
Neoadjuvant treatment provides a unique setting in which we can monitor clinical, pathological, proliferative and molecular
responses. Combining different strategies such us surgery, radiation therapy, chemotherapy, and endocrine therapy has contributed
substantially to the survival improvement in breast cancer. Third-generation aromatase inhibitors have proven to be superior
to tamoxifen in the adjuvant and, more recently, the neoadjuvant treatment of postmenopausal patients. The need to define
how to select the patients that will benefit the most from these therapies, the optimal duration of treatment, the best method
to evaluate the treatment response, the identification of predictive factors for response, and the superiority of certain
endocrine agents over others have been reviewed. We have carried out a critical analysis of the current literature on the
utilization of endocrine therapy in the neoadjuvant setting for breast cancer. This review discusses the current evidence
regarding primary endocrine therapy and the current opinions on length of treatment and measurement of response prior to surgery.
KeywordsBreast cancer–Neoadjuvant therapy–Hormone therapy–Tamoxifen–Aromatase inhibitors