title: Management of patients with metastatic breast cancer.
abstract: Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.
authors.affiliation: Oncology Department, Hospital Universitario Canarias, S/C Tenerife, Islas Canarias, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cruz Jurado
authors.forename: P
authors.initials: P
authors.lastname: Richart Aznar
authors.forename: J
authors.initials: J
authors.lastname: García Mata
authors.forename: R
authors.initials: R
authors.lastname: Fernández Martínez
authors.forename: I
authors.initials: I
authors.lastname: Peláez Fernández
authors.forename: T
authors.initials: T
authors.lastname: Sampedro Gimeno
authors.forename: E
authors.initials: E
authors.lastname: Galve Calvo
authors.forename: L
authors.initials: L
authors.lastname: Murillo Jaso
authors.forename: E
authors.initials: E
authors.lastname: Polo Marqués
authors.forename: A
authors.initials: A
authors.lastname: García Palomo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000077384:Anastrozole; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects; D047072:Aromatase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D019468:Disease Management; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016503:Drug Delivery Systems; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D000077267:Fulvestrant; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077267:Fulvestrant; D000077384:Anastrozole; D004958:Estradiol; D000077289:Letrozole; C056516:exemestane