title: Endocrine therapy in post-menopausal women with metastatic breast cancer: From literature and guidelines to clinical practice.
abstract: Current international guidelines recommend endocrine therapy as the initial treatment of choice in hormone receptor positive advanced breast cancer. Endocrine therapy has been a mainstay of hormone responsive breast cancer treatment for more than a century. To date it is based on different approaches,such as blocking the estrogen receptor through selective receptor estrogen modulators, depleting extragonadal peripheral estrogen synthesis by aromatase inhibitors or inducing estrogen receptor degradation using selective down-regulators. Despite estrogen and/or progesterone receptor positive status, up to a quarter of patients could be either primarily resistant to hormone therapies or will develop hormone resistance during the course of their disease. Different mechanisms, either intrinsic or acquired, could be implicated in endocrine resistance. In the present work available endocrine therapies and their appropriate sequences have been reviewed, and the most promising strategies to overcome endocrine resistance have been highlighted.
authors.affiliation: Surgical and Medical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, "Sapienza" University of Rome, Italy; Oncology Department, Santo Spirito Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sini
authors.affiliation: Medical Oncology Department & Breast Unit-Hospital of Brindisi and Medical Oncology Department-European Institute of Oncology, Milan, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Cinieri
authors.affiliation: Medical Oncology 2, Venetian Oncological Institute, Padova, Italy; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Conte
authors.affiliation: Department of Breast Oncology, National Cancer Institute "Fondazione Pascale", Naples, Italy.
authors.forename: Michelino
authors.initials: M
authors.lastname: De Laurentiis
authors.affiliation: Medical Oncology Department, "Sandro Pitigliani" Hospital of Prato, Istituto Toscano Tumori, Prato, Italy.
authors.forename: Angelo Di
authors.initials: AD
authors.lastname: Leo
authors.affiliation: USC Oncologia Medica, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tondini
authors.affiliation: Department of Clinical and Molecular Medicine, Medical Oncology Division, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy; IDI-IRCCS, Rome, Italy. Electronic address: paolo.marchetti@ospedalesantandrea.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D019008:Drug Resistance, Neoplasm / Q000187:drug effects* / Q000502:physiology*; D005260:Female; D006801:Humans; D017698:Postmenopause; D017410:Practice Guidelines as Topic
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Advanced breastcancer; Endocrine resistance; Endocrine therapy; Hormone receptor positive; Maintenance; Postmenopausal; Treatment