Endocrine Factors in the Outcome of Systemic Adjuvant Therapy of Early Breast Cancer (original) (raw)

Endocrine manipulation in breast cancer

Radiation Oncology

Approximately three-quarters of all invasive breast cancers in women are hormone receptor positive. Endocrine manipulation is an integral component of breast cancer treatment. Hormonal therapy in breast cancer can be given in adjuvant, neo-adjuvant, therapeutic or preventive setting but the most common and most important indication is the adjuvant therapy. Adjuvant hormonal therapy has a time tested and strongly established role to lower the risk of breast cancer coming back and new cancer developing in the other breast after defmitive treatment with surgery. Hormonal therapy also plays a significant role in palliative treatment of advanced or metastatic disease. Nee-adjuvant therapy before definitive surgery and chemoprevention in women with high risk of developing breast cancer are newer avenues of hormonal therapy. Hormonal therapy at present is only indicated for hormone receptor positive breast cancers however NCCN 2009 has recommended the consideration of trial for endocrine t...

Optimal adjuvant endocrine therapy for early breast cancer

Women's Health, 2010

Adjuvant endocrine therapy substantially reduces tumor recurrence and mortality in pre-and post-menopausal women with hormone receptor-positive early breast cancer but is ineffective in women with hormone receptor-negative tumors. Tamoxifen has been the standard adjuvant endocrine therapy for both pre-and post-menopausal women with hormone receptor-positive early breast cancer and remains the standard of care for premenopausal women. In addition to tamoxifen, ovarian ablation by surgery or radiotherapy remains an option for selected premenopausal women and trials are evaluating the role of ovarian function suppression using luteinizing hormonereleasing hormone agonists. For postmenopausal women, aromatase inhibitors are more effective than tamoxifen therapy and aromatase inhibitors and tamoxifen are regarded as standards of care. Prolonging adjuvant endocrine therapy in postmenopausal women by the sequencing of aromatase inhibitors and tamoxifen can improve outcomes further. Adjuvant endocrine therapy will probably be used for longer durations in selected postmenopausal women.

Endocrine therapy for breast cancer

Update on Cancer Therapeutics, 2006

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An updated review on the efficacy of adjuvant endocrine therapies in hormone receptor–positive early breast cancer

Current Oncology, 2009

trials have shown a definitive benefit over tamoxifen in terms of disease-free survival (dfs), benefit in terms of overall survival (os) is less clear. Early trials of tamoxifen often used os as the primary endpoint, but recent trials comparing the ais with tamoxifen have used other endpoints in addition to os to demonstrate clinical benefit, and so it is important to review the endpoints in the context of current clinical care of postmenopausal women with breast cancer.

Extended Adjuvant Endocrine Therapy in Breast Cancer: Current Status and Future Directions

Clinical Cancer Updates, 2008

The optimal duration and treatment strategies involving adjuvant endocrine therapy in early breast cancer remained largely undetermined. As data emerge on the various modalities of treatment in both pre-and postmenopausal groups, debates, and discussions continue. Most studies to date focused on the 5-year duration of treatment consisting of mainly tamoxifen. The Arimidex, Tamoxifen, Alone or in Combination (ATAC) study demonstrated that anastrozole is superior to tamoxifen and has become the mainstream treatment in postmenopausal women with early breast cancer, although the duration was arbitrarily set for 5 years, analogous to tamoxifen treatment. Several clinical trials, however, have emerged to support extended endocrine therapy as it becomes clear that the recurrence risk of breast cancer does not decrease beyond the initial 5 years of treatment. The advent of molecular signatures also plays an important role in the breast cancer profiling, and where available should be incorporated in the overall decision-making. Furthermore, side effects and noncompliance pose another issue in achieving an optimal treatment benefit. The decision-making as regards to extended endocrine treatment should therefore focus not only on the cancer biology alone but also include treatment side effects, assessment of risk of recurrence and patients' preference. In this review, we present an overview of the published studies to date as well as ongoing studies on the topic to better refine the options for adjuvant hormonal therapy. n

Evolution of endocrine adjuvant therapy for early breast cancer

Expert Opinion on Investigational Drugs, 2010

Background : Use of aromatase inhibitors in postmenopausal breast cancer, initially in advanced disease but recently also for adjuvant therapy, represents a major advance. Objective : To summarize research leading to this success and to review clinical data from large Phase III trials revealing efficacy of novel third-generation aromatase inhibitors in metastatic and early breast cancer. Methods : Literature on PubMed and on ISI Web of Science for the last 10 years was searched using the word 'aromatase'. Recent key presentations and abstracts are also included. Results/conclusion : Thirdgeneration aromatase inhibitors improve relapse-free survival compared to tamoxifen, and some trials reveal a survival advantage in early breast cancer. Although substantial data now confirm the safety of these potent compounds with respect to bone metabolism and cardiovascular risk, there is a need for continuous long-term follow-up, in particular into potential vascular effects. The mechanisms and optimal treatment of musculoskeletal and joint pain remain to be addressed. Ongoing studies evaluate sequential treatment versus monotherapy, potential differences between individual compounds and optimal duration of treatment, as well as combining aromatase inhibitors with novel targeting agents.