Table 2 Comparison of aromatase inhibitors and fulvestrant

Z1031 trial. Ellis et al. 2011 and 2017 [53, 54]

4

Exemestane 25 or letrozole 2.5 or anastrozole 1

1. pCR: 1.6% (AI 16 weeks); 5.7% (switched to chemotherapy at 2 weeks)

2. ORR (clinical palpation): 62.9% exemestane; 74.8% letrozole; 69.1% anastrozole.

3. BCS: 51% (patients mastectomy at baseline); 83% (patients marginal for BCS)

Monthly physical examination, toxicity assessment, and tumor assessment.

CARMINA 02 Lerebours et al. 2016 [28]

4 or 6

Anastrozole 1 or fulvestrant 500 mg/month

1. pCR: NR.

2. ORR (clinical palpation): 52.6% anastrozole; 36.8% fulvestrant.

3. BCS: 57.6% anastrozole; 50% fulvestrant (p = 0.5)

Clinical assessment, ultrasound, and MRI at baseline, 1 month, and 4 months.

Grassadonia et al. 2014 [65]

Mean 5.7

Anastrozole 1 or exemestane 25 or letrozole 2.5

1. pCR: 1.4%

2. ORR (clinical palpation): 86.6% (9.6% CR and 77% PR)

3. BCS: 84% (ineligible for BCS at baseline)

Caliper measurement at baseline, monthly, and before surgery.

FIRST Robertson et al. 2009 [66]

Until progression

Anastrozole 1 or fulvestrant 500 mg/month

1. pCR: NR.

2. ORR (clinical palpation): 35.5% anastrozole; 36% fulvestrant (p = 0.947)

3. BCS: NR.

Clinical and radiological tumor assessment every 12 ± 2 weeks until progression.