This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lin, N. U. Articles by Winer, E. P. Search for Related Content PubMed PubMed Citation Articles by Lin, N. U. Articles by Winer, E. P. Social Bookmarking                            What's this?

Advances in Adjuvant Endocrine Therapy for Postmenopausal Women

Nancy U. Lin, Eric P. Winer

From the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Eric P. Winer, MD, Dana-Farber Cancer Institute, 44 Binney St, Mayer 232, Boston, MA 02115; e-mail: ewiner{at}partners.org

Hormone receptor-positive cancers are the most common tumor subtype among postmenopausal women with breast cancer. Despite substantial improvements in disease-free survival and overall survival with tamoxifen and chemotherapy, recurrences still occur, and may ultimately lead to death from breast cancer. Importantly, disease recurrence includes both early and late events, with over half of all recurrences detected more than 5 years from initial breast cancer diagnosis. In recent years, a number of large, randomized trials have evaluated the role of the aromatase inhibitors (AIs) in postmenopausal women with hormone receptor-positive breast cancer. These studies have tested one of three approaches: (1) an upfront AI, (2) a sequential approach after 2-3 years of tamoxifen, and (3) extended endocrine therapy beyond 5 years. Results of these studies have challenged the previous standard of a 5-year course of tamoxifen alone. While the AIs have become a standard component of treatment for most postmenopausal women, many questions remain as to how best tailor endocrine treatment to individual patients. In addition, despite the gains achieved with the AIs, many recurrences are not prevented, and novel strategies are urgently needed, particularly for those women at high risk of recurrence. In this article, we review the efficacy and toxicity data from the available trials of endocrine therapy in the postmenopausal setting. We outline controversies in choosing the optimal endocrine approach, and we discuss selected ongoing studies. Finally, we highlight future research directions, such as the need to understand host and tumor heterogeneity.

Supported in part by the Specialized Program of Research Excellence in Breast Cancer at Dana-Farber/Harvard Cancer Center (CA89393).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Rossi, A. Morabito, F. Di Rella, G. Esposito, A. Gravina, V. Labonia, G. Landi, F. Nuzzo, C. Pacilio, E. De Maio, et al. Endocrine Effects of Adjuvant Letrozole Compared With Tamoxifen in Hormone-Responsive Postmenopausal Patients With Early Breast Cancer: The HOBOE Trial J. Clin. Oncol., July 1, 2009; 27(19): 3192 - 3197. [Abstract] [Full Text] [PDF]

				A. Costantini, A. Picardi, M. Zilli, F. Cairoli, R. Torta, P. Marchetti, W. Baile, and S. Iacobelli Discussion about switch strategy in the adjuvant hormonal therapy of breast cancer: psychological aspects of physician-patient communication Ann. Onc., June 1, 2009; (2009) mdp057v1. [Abstract] [Full Text] [PDF]

				V. Ziller, M. Kalder, U.-S. Albert, W. Holzhauer, M. Ziller, U. Wagner, and P. Hadji Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer Ann. Onc., March 1, 2009; 20(3): 431 - 436. [Abstract] [Full Text] [PDF]

				N. C Turner and A. L Jones Management of breast cancer--Part II BMJ, July 11, 2008; 337(jul11_2): a540 - a540. [Full Text]

				N. Farag, R. Burns, and S. E. Come Update: A 62-Year-Old Woman With a New Diagnosis of Breast Cancer JAMA, March 5, 2008; 299(9): 1055 - 1056. [Full Text] [PDF]