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 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.
Dellapasqua
Silvia
S
International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, 3008 Bern, Switzerland.
Castiglione-Gertsch
Monica
M
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D011960:Receptors, Estrogen; D013629:Tamoxifen / Q000627:therapeutic use
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists; D011960:Receptors, Estrogen; D013629:Tamoxifen