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Appraising Adjuvant Endocrine Therapy in Hormone Receptor Positive HER2-Negative Breast Cancer—A Literature Review
Authors:Danilo Giffoni de Mello Morais Mata  Carlos Amir Carmona  Andrea Eisen  Maureen Trudeau
Affiliation:1.Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N3M5, Canada; (C.A.C.); (A.E.); (M.T.);2.Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON M5S1A1, Canada
Abstract:
Background: Approximately 75% of breast cancer (BC) is associated with luminal differentiation expressing endocrine receptors (ER). For ER+ HER2− tumors, adjuvant endocrine therapy (ET) is the cornerstone treatment. Although relapse events steadily continue, the ET benefits translate to dramatically lengthen life expectancy with bearable side-effects. This review of ER+ HER2− female BC outlines suitable adjuvant treatment strategies to help guide clinical decision making around appropriate therapy. Methods: A literature search was conducted in Embase, Medline, and the Cochrane Libraries, using ER+ HER−, ET BC keywords. Results: In low-risk patients: five years of ET is the standard option. While Tamoxifen remains the preferred selection for premenopausal women, AI is the choice for postmenopausal patients. In the high-risk category: ET plus/minus OFS with two years of Abemaciclib is recommended. Although extended ET for a total of ten years is an alternative, the optimal AI duration is undetermined; nevertheless an additional two to three years beyond the initial five years may be sufficient. In this postmenopausal group, bisphosphonate is endorsed. Conclusions: Classifying the risk category assists in deciding the treatment route and its optimal duration. Tailoring the breadth of ET hinges on a wide array of factors to be appraised for each individualized case, including weighing its benefits and harms.
Keywords:early breast cancer   premenopausal   postmenopausal   hormone receptor positive   HER2-negative   endocrine therapy   selective estrogen receptor   aromatase inhibitors   adjuvant cyclin-dependent kinases 4/6 inhibitors   bisphosphonates
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