The choice of systemic adjuvant therapy in receptor-positive early breast cancer

Patients with endocrine-responsive breast cancer represent a distinct population for which tailored adjuvant treatments are needed. Endocrine therapy is mandatory for this population. For premenopausal patients, ovarian ablation or tamoxifen can be recommended; the combination of both, as well as th...

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Bibliographic Details
Published in:European journal of cancer (1990) 2005-02, Vol.41 (3), p.357-364
Main Authors: Dellapasqua, Silvia, Castiglione-Gertsch, Monica
Format: Article
Language:English
Subjects:
Antineoplastic Agents, Hormonal - therapeutic use
Aromatase inhibitors
Aromatase Inhibitors - therapeutic use
Biological and medical sciences
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - genetics
Breast Neoplasms - surgery
Chemotherapy
Chemotherapy, Adjuvant
Endocrine therapy
Endocrine-responsive
Estrogen Antagonists - therapeutic use
Female
Genes, erbB-2
Humans
Medical sciences
Ovarian ablation
Pharmacology. Drug treatments
Receptors, Estrogen
Tamoxifen
Tamoxifen - therapeutic use
Tumors
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Summary:Patients with endocrine-responsive breast cancer represent a distinct population for which tailored adjuvant treatments are needed. Endocrine therapy is mandatory for this population. For premenopausal patients, ovarian ablation or tamoxifen can be recommended; the combination of both, as well as the combination of ovarian ablation and aromatase inhibitors is under investigation. For postmenopausal patients, tamoxifen for 5 years is the ‘standard of care’. Anastrozole can be recommended for patients with a contraindication to tamoxifen. The addition of 5 years of letrozole after 5 years of tamoxifen has yielded benefits in terms of disease-free survival. The sequential use of tamoxifen and exemestane was superior to tamoxifen for 5 years. However, in both studies, long-term toxicity is still not fully evaluated. The addition of chemotherapy to endocrine treatment can be recommended for patients at high risk of relapse and in young patients. Chemotherapy should consist of 3–6 cycles of cyclophosphamide, methotrexate, 5-fluorouracil or of an anthracycline-containing regimen. The addition of taxanes cannot be routinely recommended in this population. Endocrine treatment should start after completion of chemotherapy.
ISSN:0959-8049
1879-0852
DOI:10.1016/j.ejca.2004.11.017