Endocrine Therapy

  • Olivia PaganiEmail author
  • Rosaria Condorelli


Most breast cancers (BC) are endocrine responsive and endocrine therapy (ET) represents the mainstay treatment in all disease settings. In the adjuvant setting, in premenopausal women, tamoxifen is the standard in low-risk patients, providing a significant reduction in both risk of recurrence and BC mortality; the addition of ovarian function suppression (OFS) to tamoxifen or the aromatase inhibitor (AI) Exemestane is recommended in patients at higher risk of relapse. In postmenopausal patients, both tamoxifen and AIs are effective: AIs demonstrated an improvement in disease-free survival and a modest benefit in overall survival. In locally advanced breast cancer, in postmenopausal women, AIs are more effective than tamoxifen in tumour shrinkage to facilitate conservative surgery. Few data are available in premenopausal women, for whom primary ET is not recommended outside of clinical trials. In the metastatic setting, ET should be preferred over chemotherapy if rapid disease response is not needed. In premenopausal women, the standard first-line therapy is tamoxifen plus OFS. In postmenopausal women, first-line treatments include AIs, tamoxifen, Fulvestrant and megestrol acetate. The optimal drug sequence after first line depends on treatment received in the neoadjuvant and first-line ABC settings. Promising results are accumulating with CDK4/6 inhibitors both in pre- and postmenopausal women .


Breast cancer Endocrine responsive Endocrine therapy Premenopausal Postmenopausal Tamoxifen Aromatase inhibitors Ovarian function suppression Adjuvant therapy Neoadjuvant therapy Metastatic therapy 



Breast cancer


Endocrine therapy/endocrine therapies


Oestrogen receptor-positive


Progesterone receptor-positive


Early Breast Cancer Trialists’ Collaborative Group


Relative risk


Ovarian function suppression


Gonadotropin-releasing hormone analogues


International Breast Cancer Study Group


Suppression of Ovarian Function Trial


Disease-free survival


Hazard ratio


Confidence interval


Aromatase inhibitor/aromatase inhibitors


Tamoxifen and Exemestane Trial


Overall survival


Hormone receptor-negative


Distant DFS


Oestrogen receptor-negative


Human epidermal growth factor receptor 2-positive


Pathologic complete response


Neoadjuvant Chemotherapy versus ENdocrine Therapy


Breast conservative surgery


Overall response rate


Preoperative endocrine prognostic index


Relapse-free survival


Preoperative Arimidex Compared to Tamoxifen


Locally advanced breast cancer


Advanced breast cancer


Time to progression


Ovarian ablation


Clinical benefit rate






Hormone receptor-positive


PI3K/Akt/mammalian target of rapamycin


Non-steroidal aromatase inhibitor

CDK4 and CDK6

Cyclin-dependent kinases 4 and 6


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Institute of Oncology and Breast Unit of Southern Switzerland, Ospedale San GiovanniBellinzona, TicinoSwitzerland
  2. 2.Department of Medical OncologyInstitute of Oncology of Southern SwitzerlandBellinzonaSwitzerland

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