title: Primary endocrine therapy as an approach for patients with localized breast cancer deemed not to be surgical candidates.
abstract: OBJECTIVE
  For women diagnosed with localized hormone-receptor-positive breast cancer who have a poor performance status or who have medical conditions precluding aggressive treatment with chemotherapy or surgery, primary endocrine therapy has been proposed as a therapeutic alternative. Given that society is rapidly aging overall, this subset of patients will likely become a greater proportion of the patient population seen by breast cancer specialists.
  
  
  RESULTS
  On the basis of the results from randomized trials in patients whose health does not permit surgery, it appears that tamoxifen achieves a similar overall survival compared with surgery plus tamoxifen, supporting the use of primary endocrine therapy. In the neoadjuvant setting, aromatase inhibitors appear superior to tamoxifen, suggesting that these agents may be the best choice in the primary endocrine therapy setting. In addition, new breakthroughs for the management of hormone-receptor-positive disease in the metastatic setting have recently been reported.
  
  
  CONCLUSIONS
  This review will discuss the rationale and evidence for primary endocrine therapy; which agents could be selected for use; and how recent advances for the management of hormone-receptor-positive disease may potentially apply to this population.
authors.affiliation: aDana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA bDepartment of Surgery, Ottawa General Hospital cOttawa Hospital Research Institute dDivision of Medical Oncology, Department of Medicine, Ottawa General Hospital, Ottawa, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Hilton
authors.forename: Angel
authors.initials: A
authors.lastname: Arnaout
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen