Current Status of Extended Adjuvant Endocrine Therapy in Early Stage Breast Cancer.
In the past decade, several endocrine treatment regimens have been developed for the adjuvant treatment of postmenopausal women with hormone receptor-positive early breast cancer, including tamoxifen, aromatase inhibitors (AI), or a combination of these. The standard duration of adjuvant endocrine treatment has been 5 years for a long time. Nevertheless, the high number of recurrences occurring after 5 years suggested that extended endocrine therapy could further improve outcome, which led to the start of several randomized clinical trials investigating the effects of extended use of endocrine therapy. The extended duration of tamoxifen has been shown to improve disease-free survival and overall survival in the ATLAS and aTTom trials. However, in postmenopausal women, AIs have been shown to be more effective when compared with tamoxifen. Based hereon, it is recommended that adjuvant endocrine therapy in postmenopausal women with early breast cancer should include an AI. Recently, the DATA, IDEAL, and NSABP B42 trials showed that extended adjuvant endocrine therapy with AIs beyond 5 years in postmenopausal women with early breast cancer did reduce the occurrence of secondary breast tumors, but had no or only a small impact on distant metastasis free survival. Furthermore, toxicity of adjuvant AIs led to gradually decreasing compliance rates and long-term toxicities to non-breast cancer-related deaths. Therefore, we suggest considering extended adjuvant treatment only in women with high-risk early breast cancer who tolerate treatment well.
['van Hellemond|Irene E G|IEG|', 'Geurts|Sandra M E|SME|', 'Tjan-Heijnen|Vivianne C G|VCG|']
D000276:Adjuvants, Immunologic D018931:Antineoplastic Agents, Hormonal D047072:Aromatase Inhibitors D001943:Breast Neoplasms D003131:Combined Modality Therapy D018572:Disease-Free Survival D005260:Female D020249:Hormone Replacement Therapy D006801:Humans D009364:Neoplasm Recurrence, Local D009367:Neoplasm Staging D013629:Tamoxifen
Endocrine therapy Breast cancer Postmenopausal Tamoxifen Aromatase inhibitor Adjuvant therapy