title: American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer.
abstract: OBJECTIVE
  To develop evidence-based guidelines, based on a systematic review, for endocrine therapy for postmenopausal women with hormone receptor-positive breast cancer.
  
  
  METHODS
  A literature search identified relevant randomized trials. Databases searched included MEDLINE, PREMEDLINE, the Cochrane Collaboration Library, and those for the Annual Meetings of the American Society of Clinical Oncology (ASCO) and the San Antonio Breast Cancer Symposium (SABCS). The primary outcomes of interest were disease-free survival, overall survival, and time to contralateral breast cancer. Secondary outcomes included adverse events and quality of life. An expert panel reviewed the literature, especially 12 major trials, and developed updated recommendations.
  
  
  RESULTS
  An adjuvant treatment strategy incorporating an aromatase inhibitor (AI) as primary (initial endocrine therapy), sequential (using both tamoxifen and an AI in either order), or extended (AI after 5 years of tamoxifen) therapy reduces the risk of breast cancer recurrence compared with 5 years of tamoxifen alone. Data suggest that including an AI as primary monotherapy or as sequential treatment after 2 to 3 years of tamoxifen yields similar outcomes. Tamoxifen and AIs differ in their adverse effect profiles, and these differences may inform treatment preferences.
  
  
  CONCLUSIONS
  The Update Committee recommends that postmenopausal women with hormone receptor-positive breast cancer consider incorporating AI therapy at some point during adjuvant treatment, either as up-front therapy or as sequential treatment after tamoxifen. The optimal timing and duration of endocrine treatment remain unresolved. The Update Committee supports careful consideration of adverse effect profiles and patient preferences in deciding whether and when to incorporate AI therapy.
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.forename: Ann Alexis
authors.initials: AA
authors.lastname: Prestrud
authors.forename: Jerome
authors.initials: J
authors.lastname: Seidenfeld
authors.forename: Holly
authors.initials: H
authors.lastname: Anderson
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Davidson
authors.forename: Karen E
authors.initials: KE
authors.lastname: Gelmon
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: Eleftherios P
authors.initials: EP
authors.lastname: Mamounas
authors.forename: Diana
authors.initials: D
authors.lastname: Rowden
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Solky
authors.forename: Maryfran R
authors.initials: MR
authors.lastname: Sowers
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic; D011987:Receptors, Steroid; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D011987:Receptors, Steroid; D013629:Tamoxifen