American Journal of Cancer

, Volume 1, Issue 4, pp 293–300 | Cite as

Treatment Options For Postmenopausal Women with Tamoxifen-Resistant Advanced Breast Cancer

Review Article
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Abstract

Tamoxifen resistance can be classified into de novo (with disease progression within 6 months of treatment) and acquired (with an initial clinical benefit of at least 6 months followed by subsequent disease progression). Further endocrine therapy tends to be the treatment of choice when acquired resistance develops, especially when there has been a long duration of response to tamoxifen, in postmenopausal women with advanced breast cancer. These endocrine agents used to be progestogens (e.g. megestrol acetate) or aminoglutethimide. They have now been replaced by third-generation aromatase inhibitors (anastrozole, letrozole and exemestane) which have shown superior efficacy and tolerability compared with the traditional agents. The pure anti-estrogen, fulvestrant, has also been shown to be at least equivalent to anastrozole and is currently being evaluated in phase III trials. Recently, the third-generation aromatase inhibitors are challenging the role of tamoxifen as a first line endocrine agent. It is, therefore, envisaged that the use of endocrine agents at the time of tamoxifen resistance (when used as a second-line therapy) would become more complex and depend on the response of prior agents used. For patients with de novo resistance, chemotherapy is the standard treatment option, although for those who refuse chemotherapy or are deemed unfit a second-line endocrine agent could be tried. Newer biological therapies such as monoclonal antibodies (e.g. trastuzumab), tyrosine kinase inhibitors (ZD1839) and cell cycle inhibitors (e.g. CCI-779) are either available for clinical use or being investigated in trials.

Keywords

Tamoxifen Aromatase Inhibitor Letrozole Anastrozole Exemestane 

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Professorial Unit of SurgeryNottingham City HospitalNottinghamUK

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