Adjuvant endocrine therapy

Abstract

The major threat of breast cancer is that of distant metastasis. An adjuvant treatment is given with the aim to reduce the risk of tumor relapse and death. An adjuvant endocrine therapy represents a treatment option to be offered to patients with estrogen-receptor (ER) and/or progesterone-receptor (PgR)-positive early breast cancer. The value of this treatment is influenced by the extent of receptor expression (patients with a greater percentage of cells that are ER- or PgR-positive derive greater benefit) and the quality of receptor expression (patients with both ER- and PgR-positive tumors derive greater benefits than patients with tumors that are ER-positive and PgR-negative or ER-negative and PgR-positive). Anyhow, as recently confirmed by the St Gallen Panelists, an adjuvant endocrine treatment should be proposed to patients with highly endocrine-responsive tumors (high expression of both ER and PgR in a majority of tumor cells) as well as to patients with incompletely endocrine-responsive breast cancer (low expression of ER and/or PgR) (Goldhirsch et al. 2007). Therefore, the majority of elderly patients are potential candidates for an adjuvant endocrine treatment since the number of tumors with ERs progressively increases with aging, with less than 20% of breast cancer cases being ER-negative in patients aged 65 years or more. Let us discuss the available options. © 2010 Springer-Verlag London.