Adjuvant hormonal therapy

Abstract

Adjuvant endocrine therapy remains important. Both tamoxifen and ovarian ablation, when used alone for estrogen receptor (ER)- and/or progesterone receptor (PgR)-positive breast cancer, produce similar effects to those of first-generation chemotherapies such as cyclophosphamide, methotrexate, and 5- fluorouracil (CMF) in premenopausal women. Concurrent use of tamoxifen and Zoladex (AstraZeneca Pharmaceuticals, Mississauga, Ontario) and/or tamoxifen and/or ovarian ablation with chemotherapy may be additionally beneficial, but more data are required. Tamoxifen alone, concurrent with, or after chemotherapy is the pivotal therapy for postmenopausal ER- and/or PgR-positive women. Current data suggest 5 years of tamoxifen as optimal, but additional studies of duration are ongoing. Third-generation aromatase inhibitors are now suggested to be equivalent to or perhaps better than tamoxifen in metastatic disease, and ongoing trials of aromatase inhibitors sequenced with, concurrent with, or substituted for tamoxifen may change our approach to postmenopausal adjuvant therapy. Adjuvant bisphosphonates seem to reduce the risk of bone metastases, but additional studies are needed to confirm their routine use. Copyright (C) 2000 by W.B. Saunders Company.