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Review
. 2018 Apr 27;19(5):26.
doi: 10.1007/s11864-018-0541-1.

Current Status of Extended Adjuvant Endocrine Therapy in Early Stage Breast Cancer

Irene E G van Hellemond  1 , Sandra M E Geurts  1 , Vivianne C G Tjan-Heijnen  2
Affiliations
Review

Current Status of Extended Adjuvant Endocrine Therapy in Early Stage Breast Cancer

Irene E G van Hellemond et al. Curr Treat Options Oncol. .

Abstract

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.

Keywords: Adjuvant therapy; Aromatase inhibitor; Breast cancer; Endocrine therapy; Postmenopausal; Tamoxifen.

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Conflict of interest statement

Conflict of Interest

Irene E.G. van Hellemond has received research funding through a grant to her institution from AstraZeneca for the DATA study, and has received reimbursement for travel expenses from Roche.

Sandra M.E. Geurts has received research funding through grants to her institution from Novartis BV, Roche, and Pfizer.

Vivianne C.G. Tjan-Heijnen has received research funding through grants to her institution from Eisai, Roche, Pfizer, Novartis, and AstraZeneca; has received compensation from AstraZeneca, Pfizer, Novartis, and Roche for service as a consultant; has received honoraria from Pfizer, Roche, and Novartis; and has received reimbursement for travel expenses from Pfizer, Novartis, and Roche.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Figures

Fig. 1
Fig. 1
Adjuvant endocrine treatment in postmenopausal women with early stage hormone receptor-positive breast cancer. AI, aromatase inhibitor; T, tamoxifen.
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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