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Optimizing aromatase inhibitor integration into initial treatment strategies in postmenopausal women with hormone-receptor-positive early breast cancer

  • Optimizing Breast Cancer Patient
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Abstract

After local therapy, women with early breast cancer remain at risk of recurrence for an extended period. For women with hormone-receptor-positive (HR+) disease, the risk of relapse peaks in the first 2–3 years after surgery. Distant metastases, which are associated with a high risk of death from breast cancer, account for the majority of relapses, both early and late. Preventing distant metastases is therefore a primary aim of systemic adjuvant treatment. Tamoxifen was the mainstay of endocrine adjuvant treatment for HR+ disease, but despite its proven benefits, a significant proportion of patients will relapse while on tamoxifen therapy. The third-generation aromatase inhibitors (AIs)—letrozole, anastrozole, and exemestane—have recently replaced tamoxifen as the recommended adjuvant endocrine therapy, on the basis of greater efficacy and better tolerability. However, the optimal use of AIs in the adjuvant setting requires further investigation, including identification of the best treatment strategy. Although a switching strategy does reduce relapses, only upfront AI therapy can address the early peak of distant recurrences that occur despite tamoxifen. Similarly, only upfront AI therapy can avoid the life-threatening side effects that occur in the early years of tamoxifen therapy. Available evidence supports a hypothesis that upfront adjuvant AI therapy is the most appropriate treatment strategy for postmenopausal patients with HR+ disease. Definitive evidence awaits results from ongoing randomized trials.

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Financial disclosure/conflict of interest statement

The author of this article is a consultant for AstraZeneca, Novartis, Pfizer and is on speaker's panel for AstraZeneca and Novartis. He has no other commercial associations that might pose a conflict of interest in connection with the submitted article. The author of this article has no commercial associations (e.g., consultancies, stock ownership, equity interests, patentlicensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All funding sources supporting the work and all institutional or corporate affiliations of the author are acknowledged.

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  1. Division of Medical Oncology and Hematology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90502, USA

    Rowan T. Chlebowski

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Chlebowski, R.T. Optimizing aromatase inhibitor integration into initial treatment strategies in postmenopausal women with hormone-receptor-positive early breast cancer. Breast Cancer Res Treat 112 (Suppl 1), 25–34 (2008). https://doi.org/10.1007/s10549-008-0237-5

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