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Endocrine Therapy

  • Olivia PaganiEmail author
  • Rosaria Condorelli
Chapter

Abstract

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 .

Keywords

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

Abbreviations

BC

Breast cancer

ET/ETs

Endocrine therapy/endocrine therapies

ER+

Oestrogen receptor-positive

PR+

Progesterone receptor-positive

EBCTCG

Early Breast Cancer Trialists’ Collaborative Group

RR

Relative risk

OFS

Ovarian function suppression

GnRHa

Gonadotropin-releasing hormone analogues

IBCSG

International Breast Cancer Study Group

SOFT

Suppression of Ovarian Function Trial

DSF

Disease-free survival

HR

Hazard ratio

CI

Confidence interval

AI/AIs

Aromatase inhibitor/aromatase inhibitors

TEXT

Tamoxifen and Exemestane Trial

OS

Overall survival

HR−

Hormone receptor-negative

DDFS

Distant DFS

ER−

Oestrogen receptor-negative

HER2+

Human epidermal growth factor receptor 2-positive

pCR

Pathologic complete response

NeoCENT

Neoadjuvant Chemotherapy versus ENdocrine Therapy

BCS

Breast conservative surgery

ORR

Overall response rate

PEPI

Preoperative endocrine prognostic index

RFS

Relapse-free survival

PROACT

Preoperative Arimidex Compared to Tamoxifen

LABC

Locally advanced breast cancer

ABC

Advanced breast cancer

TTP

Time to progression

OA

Ovarian ablation

CBR

Clinical benefit rate

LD

Low-dose

HD

High-dose

HR+

Hormone receptor-positive

mTOR

PI3K/Akt/mammalian target of rapamycin

NSAI

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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