Appraising Adjuvant Endocrine Therapy in Hormone Receptor Positive HER2-Negative Breast Cancer—A Literature Review

Round 1

Reviewer 1 Report

The authors reviewed the adjuvant endocrine treatment strategies to help decision-making in the case of HR+ HER2- patients, focusing on their indications, advantages, efficacy and side effects.

The argument is interesting for multiple reasons. First, this group of patients represents the majority of breast cancer patients. Second, there are many different endocrine therapies and it is important to know which to chose based on their specific characteristics.  

I probably would have only added some considerations regarding the use of anti-hormonal therapy in patients with gene mutations (obviously above all the carriers of a mutation of the BrCa2 gene as they are more predisposed to developing endocrine responsive tumors), which represent a not negligible reality within the breast cancer patients.

In my opinion, this review is well structured and complete in the description of the various possibilities. Therefore, I think it is suitable for publication.

Author Response

Point 1: The authors reviewed the adjuvant endocrine treatment strategies to help decision-making in the case of HR+ HER2- patients, focusing on their indications, advantages, efficacy and side effects.

The argument is interesting for multiple reasons. First, this group of patients represents the majority of breast cancer patients. Second, there are many different endocrine therapies and it is important to know which to chose based on their specific characteristics.  

I probably would have only added some considerations regarding the use of anti-hormonal therapy in patients with gene mutations (obviously above all the carriers of a mutation of the BrCa2 gene as they are more predisposed to developing endocrine responsive tumors), which represent a not negligible reality within the breast cancer patients.

In my opinion, this review is well structured and complete in the description of the various possibilities. Therefore, I think it is suitable for publication.

Response 1: Dear editor, thank you for reviewing our manuscript. Our team appreciates your feedback. We added a paragraph in the introduction section regarding the topic suggested.

Reviewer 2 Report

The review article by Mata et al. summarizes the existing knowledge based on literature search  on HR+ HER2- female breast cancer suitable adjuvant strategies to help guide clinical decision making in addition to the appropriate available therapies. In this review article, the authors have conducted a literature search on various databases like Embase, Medline, and the Cochrane libraries. The article highlights latest information of ET and its optimal treatment options, along with aromatase inhibitors, SERM’s and ovarian function suppressors as well as CDK4/6 inhibitors and bisphosphonates. The article is well written. The article is divided into sub topics which makes it easy to read and follow. However, I feel there needs to be few changes made to the article. Please see below:

1)    It would have been  better if the authors would have included/mentioned  how many reviews/articles from all the database were included in their review article. A mention under methods and material section or small table or flow chart would be fine.

2)    Also, the numbering of the sections in the article is not required. Rather than just writing the heading they can include a statement like the main idea of the paragraph or the interpretation.

3)    The authors can also include a table where all the major clinical trials mentioned in the article are mentioned so that the readers can get all the major information at a glance.  

4)    Please align the table 1.

1)    The title of the manuscript can be -      Appraising…..: a review article …..a review article can be replaced with a literature review. 

Author Response

The review article by Mata et al. summarizes the existing knowledge based on literature search  on HR+ HER2- female breast cancer suitable adjuvant strategies to help guide clinical decision making in addition to the appropriate available therapies. In this review article, the authors have conducted a literature search on various databases like Embase, Medline, and the Cochrane libraries. The article highlights latest information of ET and its optimal treatment options, along with aromatase inhibitors, SERM’s and ovarian function suppressors as well as CDK4/6 inhibitors and bisphosphonates. The article is well written. The article is divided into sub topics which makes it easy to read and follow. However, I feel there needs to be few changes made to the article. Please see below:

Point 1:  It would have been better if the authors would have included/mentioned  how many reviews/articles from all the database were included in their review article. A mention under methods and material section or small table or flow chart would be fine. 

Response 1: Dear editor, thank you for your thorough comments and feedback. They are very helpful to enhance the quality of our work and to reach our goal in making a positive impact within the breast cancer scientific community. Following the template by Current Oncology for standardized literature review articles, we stated the timeframe for the literature search and the outlined search libraries (eg. Embase, Medline etc) under the methodology section. The requirements of flow charts, such as PRISMA diagram, are requirements for manuscripts that falls into Systematic Review +/- Meta-analysis category. We acknowledge your suggestion as this would be an addition to the manuscript. As this information was not part of our initial plan, and an updated review was performed in April, we do not have record of the accurate number of studies reviewed.

Point 2: Also, the numbering of the sections in the article is not required. Rather than just writing the heading they can include a statement like the main idea of the paragraph or the interpretation.

Response 2: Thank you for your suggestion. Appropriate edits were made.

Point 3: The authors can also include a table where all the major clinical trials mentioned in the article are mentioned so that the readers can get all the major information at a glance.

Response 3: Thank you for your suggestion. Our team included a table 3, following your suggestions.

Point 4: Please align the table 1

Response 4: Thank you. Appropriate alignment to table 1 was made, as per your suggestion.

Point 5: The title of the manuscript can be -      Appraising…..: a review article …..a review article can be replaced with a literature review. 

Response 5: Thank you. Our group strongly agrees with your suggestion. The outlined modification was made to the manuscript title.

Reviewer 3 Report

1.      The review lacks novelty and puts up all the known information at one place. Moreover, lack of figures and graphical representation makes it less attractive. The authors are advised to add some new figures that will improve the overall structure of the article.

2.      Add References for each drug mentioned in Table 1.

3.      Avoid erratic usage of abbreviations. Use of abbreviations must be consistent throughout the manuscript.

4.      Conclusion section must be improved.

5.      A few lines pertaining to general introduction of cancer must be added in the Introduction section at the start that will aid in the continuity.

Author Response

Point 1: The review lacks novelty and puts up all the known information at one place. Moreover, lack of figures and graphical representation makes it less attractive. The authors are advised to add some new figures that will improve the overall structure of the article. 

Response 1: Dear editor, thank you for your comments. To better organize the manuscript, our team tried to divide the topics into 8 sub-sections accordingly.  Our team has also added a new table to the manuscript, as this is a summary compiled with results of relevant clinical trials and systematic review and meta-analyses over the past two decades.

Point 2: Add References for each drug mentioned in Table 1.

Response 2: Thank you for your suggestion. We have added references as suggested.

Point 3: Avoid erratic usage of abbreviations. Use of abbreviations must be consistent throughout the manuscript.

Response 3: Thank you for your recommendation. Our team reviewed all the abbreviations used and corrections were made accordingly.

Point 4: Conclusion section must be improved.

Response 4: Facing the limitations of word counting, slight changes were made to the conclusion. 

Point 5: A few lines pertaining to general introduction of cancer must be added in the Introduction section at the start that will aid in the continuity.

Response 5: Thank you for your recommendation. We expanded the introduction with general information, as well as a briefly outlined breast cancer subgroups that are likely to develop endocrine response.

Round 2

Reviewer 3 Report

All the concerns have been addressed and the manuscript can now be accepted for publication.