title: Clinical strategies for rationale combinations of aromatase inhibitors with novel therapies for breast cancer.
abstract: Improving endocrine responsiveness and preventing the development of resistance is the goal of many current strategies that are looking to combine aromatase inhibitors with novel drugs that target various pathways in estrogen receptor (ER) positive breast cancer. Pre-clinical models of acquired resistance to aromatase inhibitors have suggested an increase in several signaling pathways including peptide growth factor signaling (EGFR, HER2) and activation of the mTOR signaling pathway. These may result in associated 'cross-talk' activation of ER-dependent gene transcription, such that dual blockade of ER together with other signaling pathways has become a logical approach to improve endocrine responsivness. Clinical strategies with aromatase inhibitors are looking to prevent activation of these pathways either through combination with the selective ER downregulator fulvestrant, or with various signal transduction inhibitors (STIs) including monoclonal antibodies (trastuzumab), small molecule tyrosine kinase inhibitors (TKIs) against EGFR or HER2 (lapatinib, gefitinib) and mTOR antagonists (temsirolimus). Early clinical data have emerged this year for some of these approaches with mixed results. This article reviews the rationale for these strategies, and discusses the lessons that need to be learnt if we are to successfully integrate these new drugs with aromatase inhibitors in the clinic.
authors.affiliation: Department of Medicine, Royal Marsden Hospital, London SW3 6JJ, UK. stephen.johnston@rmh.nhs.uk
authors.forename: Stephen R D
authors.initials: SR
authors.lastname: Johnston
authors.forename: Lesley-Ann
authors.initials: LA
authors.lastname: Martin
authors.forename: Alex
authors.initials: A
authors.lastname: Leary
authors.forename: Julia
authors.initials: J
authors.lastname: Head
authors.forename: Mitch
authors.initials: M
authors.lastname: Dowsett
mesh_terms: D000818:Animals; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D019008:Drug Resistance, Neoplasm; D004359:Drug Therapy, Combination; D006801:Humans; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D015398:Signal Transduction
chemical_list: D047072:Aromatase Inhibitors; D018719:Erb-b2 Receptor Tyrosine Kinases