Aromatase inhibitors in premenopause: Great expectations fulfilled?
Tamoxifen and GnRH analogues (GnRHa) represent the mainstay of endocrine manipulations in premenopausal women. The estrogen blockade obtained by aromatase inhibitors (AIs) plus GnRHa suppresses circulating estrogens more deeply than tamoxifen plus GnRHa. Retrospective and prospective evidence confirm a substantial activity for AIs and GnRHa in locally advanced and metastatic breast cancer. In early breast cancer inconsistent evidence emerged from 2 large randomized studies with anastrozole performing as tamoxifen in terms of DFS, but significantly worse as of OS while exemestane outperformed tamoxifen as of DFS particularly in very young and high-risk women. These findings support the use of AIs plus GnRHa in advanced breast cancer while long term efficacy and safety data are expected to define the appropriate indication of AIs in early breast cancer. In addition the clinical significance of persistent circulating estrogens and long term effects of estrogen deprivation in young women need further clarification.
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: rosalba.torrisi@humanitas.it.
Rosalba
R
Torrisi
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: selene.rota@humanitas.it.
Selene
S
Rota
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: agnese.losurdo@humanitas.it.
Agnese
A
Losurdo
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: monica.zuradelli@humanitas.it.
Monica
M
Zuradelli
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: giovanna.masci@humanitas.it.
Giovanna
G
Masci
Dept of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Humanitas University, Viale Manzoni 56, 20089 Rozzano, Italy. Electronic address: armando.santoro@humanitas.it.
Armando
A
Santoro
D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy; D018450:Disease Progression; D004967:Estrogens / Q000378:metabolism; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D017697:Premenopause
D047072:Aromatase Inhibitors; D004967:Estrogens
Aromatase inhibitors; Breast cancer; Circulating estradiol; Ovarian suppression; Premenopause