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Journal articles on the topic 'Adjuvant hormone therapy'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Boyages, John, and Ken W. Tiver. "ADJUVANT SYSTEMIC THERAPY IN BREAST CANCER PART 1: ADJUVANT HORMONE THERAPY." ANZ Journal of Surgery 62, no. 5 (May 1992): 354–63. http://dx.doi.org/10.1111/j.1445-2197.1992.tb07203.x.

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2

Gupta, S., M. Singh, Amish Vora, G. Babu, M. Walia, V. Nautial, R. Saha, et al. "Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer." South Asian Journal of Cancer 07, no. 02 (April 2018): 142–45. http://dx.doi.org/10.4103/sajc.sajc_122_18.

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AbstractOptimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

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3

Latif, Asma, Alexander C. Small, Erin L. Moshier, Kerin B. Adelson, George Raptis, James H. Godbold, William K. Oh, and Matt D. Galsky. "Practice patterns in the use of adjuvant therapy for post-menopausal early-stage breast cancer in the pre- and post-Oncotype DX era." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e21032-e21032. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e21032.

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e21032 Background: Personalized oncology offers the promise of selectively applying therapeutics to patients most likely to benefit, while sparing those unlikely to benefit from potentially toxic therapies. Oncotype DX is a 21-gene assay utilized to identify hormone-receptor positive (HR+), node negative, breast cancer (Br CA) patients who may be successfully treated with adjuvant hormonal therapy alone. We hypothesized that practice patterns with adjuvant therapy have changed since the commercial availability of Oncotype DX in 2004. Methods: The Public National Cancer Database was queried to identify patients age ≥ 50 with stage I or II Br CA diagnosed from 2000 to 2008. Patients were classified by adjuvant therapy including hormone, chemotherapy, hormone and chemotherapy, and no hormone or chemotherapy. Log-binomial regression was used to estimate prevalence ratios for the proportion of patients receiving adjuvant therapies from 2000-2003 compared to 2004-2008. Results: 833,018 patients age ≥ 50 with stage I or II Br CA were identified. The application of adjuvant therapies for the periods pre- and post-availability of Oncotype DX are detailed in the Table. Conclusions: There has been significant increase (13%) in the use of hormonal therapy alone as adjuvant therapy for patients age ≥ 50 with HR+ stage I-II Br CA since commercial availability of Oncotype DX. While this has been slightly offset by a decrease in the use of chemotherapy plus hormonal therapy, there has been a larger decrease in the use of “no adjuvant therapy”. Data regarding predictive biomarkers should be captured by registries in an effort to determine the true impact of these tests on treatment utilization. [Table: see text]

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4

Zeng, Erwei, Wei He, Jenny Bergqvist, and Kamila Czence. "Abstract P3-12-04: Extending therapy after 5-year adjuvant hormone therapy in breast cancer patients: A population-based study." Cancer Research 82, no. 4_Supplement (February 15, 2022): P3–12–04—P3–12–04. http://dx.doi.org/10.1158/1538-7445.sabcs21-p3-12-04.

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Abstract Background: Clinical guidelines have recommended breast cancer patients with certain characteristics to extend their therapy after 5-year adjuvant hormone therapy. However, no study thus far has described the prevalence, predictors, and outcomes of extending adjuvant hormone therapy in the real world. Methods: We identified 2,937 breast cancer patients who completed 5-year adjuvant hormone therapy during 2010-2019 in Stockholm, Sweden, by linking the Quality Register for Breast Cancer, Prescribed Drug Register, and Cause-of-death Register. We followed them until September 2020. Extended adjuvant hormone therapy was defined as having at least 2 prescriptions of tamoxifen and/or aromatase inhibitors after completing 5-year therapy. We used logistic regression to examine predictors of extended adjuvant hormone therapy and Cox regression to examine whether extended therapy is associated with distant metastasis-free survival, disease-free survival and all-cause mortality. Results: The proportion of extending therapy after 5-year adjuvant hormone therapy increased by 7 times during the past decade, from 8.8% in 2010 to 63.7% in 2019. Predictors of extended adjuvant hormone therapy included young age (≤50 years) at extension, positive lymph node status, high tumor grade and chemotherapy, among which chemotherapy was the strongest predictors [adjusted hazard ratio (HR), 4.64 (95% CI, 3.64-5.92)]. Among patients with chemotherapy, extended therapy improved distant metastasis-free survival [adjusted HR, 0.34 (95 CI%, 0.15-0.78)] and disease-free survival [adjusted HR, 0.61 (95 CI%, 0.39-0.95)]. Therapy discontinuation rates were similar during the first and second five years. Conclusion: Increasing number of breast cancer patients are extending adjuvant hormone therapy, even among patients without clear recommendations in clinical guidelines. Our findings support extended adjuvant hormone therapy in breast cancer patients with chemotherapy. Citation Format: Erwei Zeng, Wei He, Jenny Bergqvist, Kamila Czence. Extending therapy after 5-year adjuvant hormone therapy in breast cancer patients: A population-based study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-04.

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5

Wiltshaw, E. "Adjuvant hormone therapy in ovarian cancer." Biomedicine & Pharmacotherapy 46, no. 4 (January 1992): 176. http://dx.doi.org/10.1016/0753-3322(92)90032-3.

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6

Blomqvist, Carl P., Inkeri Elomaa, and Pentti Rissanen. "Adjuvant Hormone Therapy in Breast Cancer." Annals of Medicine 24, no. 2 (January 1992): 91–96. http://dx.doi.org/10.3109/07853899209148333.

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7

Kovalenko, E. I., I. B. Kononenko, A. V. Snegovoi, O. P. Grebennikova, and L. V. Manzyuk. "Adverse effects of adjuvant endocrine therapy." Medical Council, no. 10 (July 19, 2018): 64–69. http://dx.doi.org/10.21518/2079-701x-2018-10-64-69.

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Hormonal therapy is a highly effective and well tolerable treatment of hormone-responsive breast cancer. However, it has some side effects that can affect quality of life and lead to treatment discontinuation. Common side effects of tamoxifen and aromatase inhibitors are discussed in this article: menopausal, gynecological symptoms, cardiovascular and musculoskeletal adverse events. Some of them are preventable and manageable. In order to maintain good quality of life during treatment the oncologists should pay more attention to the side effects that lead to it’s deterioration and not be too anxious about insignificant ones.

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8

Loibl, S., G. von Minckwitz, and M. Kaufmann. "Adjuvant hormone therapy following primary therapy for endometrial cancer." European Journal of Cancer 38 (September 2002): 41–43. http://dx.doi.org/10.1016/s0959-8049(02)00281-2.

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9

Slonimskaya, E. M., A. V. Doroshenko, P. V. Kazantseva, N. A. Tarabanovskaya, and R. Yu Vernadsky. "Individual approach to choosing an appropriate regimen of adjuvant hormone therapy in patients with early-stage breast cancer." Tumors of female reproductive system 14, no. 3 (October 16, 2018): 48–54. http://dx.doi.org/10.17650/1994-4098-2018-14-3-48-54.

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Adjuvant hormone therapy is considered the gold standard of therapy for hormone receptor-positive operable breast cancer. The approach to adjuvant hormone therapy in premenopausal patients has changed significantly in recent years. This change was caused by clinical trials, which have confirmed the advantage of adding ovarian suppression to tamoxifen or aromatase inhibitors monotherapy. Individual approach to choosing an appropriate regimen of adjuvant hormone therapy in premenopausal patients with breast cancer should be based on the assessment of risks for relapse, expected effectiveness of treatment and evaluation of drug safety.

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10

Cutolo, Maurizio. "SEX HORMONE ADJUVANT THERAPY IN RHEUMATOID ARTHRITIS." Rheumatic Disease Clinics of North America 26, no. 4 (November 2000): 881–95. http://dx.doi.org/10.1016/s0889-857x(05)70174-5.

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11

Neven, P. "ADJUVANT THERAPY FOR HORMONE-DEPENDENT BREAST CANCER." International Journal of Gynecologic Cancer 13, Suppl 1 (March 2003): 116.1–116. http://dx.doi.org/10.1136/ijgc-00009577-200303001-00433.

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12

Kimmick, Gretchen, Roger Anderson, Fabian Camacho, Monali Bhosle, Wenke Hwang, and Rajesh Balkrishnan. "Adjuvant Hormonal Therapy Use Among Insured, Low-Income Women With Breast Cancer." Journal of Clinical Oncology 27, no. 21 (July 20, 2009): 3445–51. http://dx.doi.org/10.1200/jco.2008.19.2419.

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Purpose Use of adjuvant hormonal therapy, which significantly decreases breast cancer mortality, has not been well described among poor women, who are at higher risk of cancer-related death. Here we explore use of adjuvant hormonal therapy in an insured, low-income population. Methods A North Carolina Cancer Registry–Medicaid linked data set was used. Women with hormone receptor–positive or unknown, nonmetastatic breast cancer, diagnosed between 1998 and 2002, were included. Main outcomes were (1) prescription fill within 1 year of diagnosis, (2) adherence (medication possession ratio), and (3) persistence (absence of a 90-day gap in prescription fills over 12 months). Results The population consisted of 1,491 women (mean age, 67 years). Sixty-four percent filled prescriptions. Predictors of prescription fill included the following: older age (odds ratio [OR], 1.01; P = .017), greater number of prescription medications (OR, 1.06; P < .001), nonmarried status (OR, 1.82; P = .001), higher stage (OR, 1.83; P < .001), positive hormone receptor status (positive v unknown, OR, 1.98; P < .001), not receiving adjuvant chemotherapy (OR, 1.74; P = .001), receipt of adjuvant radiation (OR, 1.55; P = .004), and treatment in a small hospital (OR, 1.49; P = .024). Adherence and persistence rates were 60% and 80%, respectively. Nonmarried status predicted greater adherence (OR, 1.90; P = .006) and persistence (OR, 1.75; P = .031). Conclusion Prescription fill, adherence, and persistence to adjuvant hormonal therapy among socioeconomically disadvantaged women are low. Improving use of adjuvant hormonal therapy may lead to lower breast cancer–specific mortality in this population.

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13

McArthur, H. L., and H. F. Kennecke. "Rationale for Extended Adjuvant Letrozole after Five Years of Tamoxifen in Postmenopausal Oestrogen Receptor–Positive Women with Early-Stage Breast Cancer." Current Oncology 12, no. 3 (September 1, 2005): 78–82. http://dx.doi.org/10.3390/curroncol12030003.

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14

Jones, Kellie L., and Aman U. Buzdar. "A review of adjuvant hormonal therapy in breast cancer." Endocrine-Related Cancer 11, no. 3 (September 2004): 391–406. http://dx.doi.org/10.1677/erc.1.00594.

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Breast cancer is the most common carcinoma diagnosed in women today excluding non-melanoma skin cancers. It has been well documented that estrogen plays a critical role in its development and is a major target for treatment. For many years, tamoxifen has been the gold standard for adjuvant hormonal therapy in breast cancer patients. With newer products targeting different mechanisms to suppress estrogen production, patients now have many decisions regarding their care. Agents such as luteinizing hormone releasing hormone (LHRH) agonists can suppress ovarian function in premenopausal patients and have been shown to be as effective and even better than chemotherapy (CMF — cyclophosphamide, methotrexate, fluorouracil-containing regimens) in certain patient populations. Tamoxifen continues to be an option as well as toremifene, a similar selective estrogen receptor modulator. With the advent of newer third generation aromatase inhibitors (anastrozole, letrozole and exemestane) toxicities have been documented to be less and in some cases they are more efficacious than the standard, tamoxifen. This article reviews the current data regarding ovarian suppression, ovarian suppression plus tamoxifen, tamoxifen, toremifene, anastrozole, letrozole, and exemestane in the treatment of adjuvant hormonal-sensitive breast cancer.

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15

Kaisary, A. V., and M. Jarmulowicz. "Adjuvant Luteinising Hormone-Releasing Hormone (LHRH)—Agonist Therapy in Prostate Cancer." UroOncology 3, no. 2 (June 2003): 51–62. http://dx.doi.org/10.1080/1561095031000148772.

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16

Ditonno, Pasquale, Michele Battaglia, and Francesco Paolo Selvaggi. "Adjuvant Hormone Therapy after Radical Prostatectomy: Indications and Results." Tumori Journal 83, no. 2 (March 1997): 567–75. http://dx.doi.org/10.1177/030089169708300219.

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Despite recent advances in staging modalities, nearly 30–40% of patients undergoing radical prostatectomy for clinically localized prostate cancer have residual disease. In these cases, one or more of the following conditions may be present: extracapsular disease, positive margins, invasion of the seminal vesicles, lymph node metastases or the postoperative persistence of PSA values above the biological threshold. The optimal management for residual prostate cancer remains controversial and in this setting adjuvant therapy could be appropriate. In the present review we examine the conditions in which hormonal adjuvant therapy can be indicated and the results available from retrospective or non-randomized studies. From the data in the literature and in the absence of randomized prospective studies, prudent conclusions could be drawn on the efficacy of adjuvant hormonal therapy. In cases of small volume, low grade (Gleason score «7) prostate cancer in stage C or D1, radical surgery coupled with adjuvant hormonal therapy leads to survival rates in stage C similar to those in the intraprostatic stage, and in stage D1 with minimal lymph involvement, seems to delay clinical development of metastases. Finally, the quality of life associated with adjuvant therapy and the drug regimens available for this therapy are reviewed.

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17

Giordano, Sharon H., Gabriel N. Hortobagyi, Shu-Wan C. Kau, Richard L. Theriault, and Melissa L. Bondy. "Breast Cancer Treatment Guidelines in Older Women." Journal of Clinical Oncology 23, no. 4 (February 1, 2005): 783–91. http://dx.doi.org/10.1200/jco.2005.04.175.

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Purpose To determine patterns and predictors of concordance with institutional treatment guidelines among older women with breast cancer. Methods The study population included 1,568 patients aged 55 years and older who were treated at M.D. Anderson Cancer Center between July 1997 and January 2002 for stage I to IIIA invasive ductal and lobular breast cancer. Concordance with institutional guidelines was determined for definitive surgical therapy, radiotherapy after breast-conserving surgery, radiation therapy after mastectomy, adjuvant chemotherapy use, and adjuvant hormonal therapy use. The following variables were considered as possible modifiers of concordance: patient age, marital status, race, educational level, Eastern Cooperative Oncology Group performance status, comorbidity score, clinical stage, hormone receptor status, HER2-neu status, tumor grade, pathologic tumor size, lymphatic invasion, and number of lymph nodes involved. Logistic regression modeling was performed to determine the independent effect of each variable on guideline concordance. Results Older women were less likely to receive treatment in concordance with guidelines for definitive surgical therapy (P < .001), postlumpectomy radiation (P = .03), adjuvant chemotherapy (P < .001), and adjuvant hormonal therapy (P < .001). In multivariate analysis, age ≥ 75 years predicted a deviation from guidelines for definitive surgical therapy, adjuvant chemotherapy, and adjuvant hormonal therapy. Nonwhite race was associated with decreased likelihood of adjuvant radiation therapy after breast conservation. Conclusion After adjustment for comorbidity score, race, marital status, educational status, clinical stage, and tumor characteristics, increasing patient age was independently associated with decreased guideline concordance for definitive surgery, adjuvant chemotherapy, and adjuvant hormonal therapy. Future research should focus on delineating the possible reasons for guideline discordance.

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18

Van Poppel, Hein. "Neoadjuvant and Adjuvant Hormone Therapy: How and When?" European Urology Supplements 7, no. 13 (December 2008): 747–51. http://dx.doi.org/10.1016/j.eursup.2008.09.001.

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19

Bossi, Alberto. "Who Benefits from Neoadjuvant or Adjuvant Hormone Therapy?" European Urology Supplements 8, no. 12 (December 2009): 848–51. http://dx.doi.org/10.1016/j.eursup.2009.09.003.

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20

Zlotta, Alexandre R., and Claude C. Schulman. "Neoadjuvant and adjuvant hormone therapy for prostate cancer." World Journal of Urology 18, no. 3 (June 16, 2000): 179–82. http://dx.doi.org/10.1007/s003450000119.

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21

Karakas, Yusuf, Serkan Akin, Omer Dizdar, and Sercan Aksoy. "Analysis of the Adjuvant Hormone Therapy Randomized Trial." Journal of Clinical Oncology 34, no. 17 (June 10, 2016): 2070. http://dx.doi.org/10.1200/jco.2015.65.4277.

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22

Voutsadakis, Ioannis A. "On Adjuvant Hormone Therapy in Epithelial Ovarian Cancer." Journal of Clinical Oncology 34, no. 17 (June 10, 2016): 2070–71. http://dx.doi.org/10.1200/jco.2015.66.3245.

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23

Kimmick, G. G., F. Camacho, W. Hwang, and R. T. Anderson. "The relationship between adherence to adjuvant hormonal therapy and survival among low-income, insured women with primary breast cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11522-e11522. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11522.

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e11522 Background: Clinical trials and meta-analyses show that adjuvant hormonal therapy for hormone receptor positive breast cancer significantly decreases risk of death. We explored the relationship between adherence to adjuvant hormonal therapy and death in a low-income, Medicaid-insured population. Methods: Using a Medicaid claims-tumor registry linked database and National Death Index data (NDI), we evaluated adherence to adjuvant hormonal therapy [defined as >80% Medication Possession Ratio (MPR)] and mean six-year overall and cancer-specific survival by local versus regional stage for all female breast cancer diagnosed in years 2000–2002, in North Carolina. The Kaplan-Meier and Cox Proportional Hazards models were used to determine the role of adherence on cancer-specific survival. Models were adjusted for age, race, Charlson comorbidity score, number of prescription medications, type of surgery, use of radiation therapy, prior chemotherapy, hormone receptor status (positive or unknown). Results: The final sample consisted of 1,042 cases [ages range 29–97 years (mean 65.9 years; 56% Caucasian; mean Charlson comorbidity score 4.1 (SD 2.9); 680 local and 362 regional stage], of which 732 filled a prescription for adjuvant hormonal therapy within the year after breast cancer diagnosis. Filling a prescription for adjuvant hormonal therapy, versus not, was not significantly associated with cancer-related death: HR 1.04 (95% CI 0.66 - 1.64) overall; HR 0.75 (95% CI 0.39 - 1.43) for local stage and HR 1.01 (95% CI 0.51 - 2.00) for regional stage. However, adherence in the highest quartile (MPR>95) is associated with an increase in mortality risk. Conclusions: In this low income insured group of breast cancer patients, no statistically significant association was found between death rates and use of adjuvant hormonal therapy. However, an unexpected association between very high adherence and increase in mortality was found. This may reflect methodological limitations of claims data involving bias and unidentified patient risk. More research is needed to explore reasons for higher mortality among low-income women with high medication adherence. [Table: see text]

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24

Thomas, Christian A. "Early-stage breast cancer patients reporting difficulty sleeping, mood issues, or pain are more likely to refuse adjuvant hormone therapy." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e12065-e12065. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12065.

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e12065 Background: Adjuvant hormone therapy is a crucial part of the treatment for patients with early stage breast cancer and an important quality measure for programs such as QOPI and the oncology care model (OCM). However, it is not known which factors influence some patients with early stage breast cancer to decline adjuvant hormone therapy. We hypothesized that specific self-reported symptoms might impact a patient’s decision to accept or decline adjuvant hormone therapy. Methods: Patients with stage 0 or I breast cancer were identified by chart review from 2011-2016 and de-identified. On the day patients received a recommendation for adjuvant treatment the following patient reported outcome measures (PROs) were analyzed: difficulty sleeping (DS), fatigue (F), mood (M such as anxiety and depression), and pain (P) on a 0-4 symptom scale based on CTCAE v. 4. PROs were then linked with a patient’s decision to accept or decline adjuvant therapy. Results: A total of 287 patients with stage 0 (n = 80) or stage I (n = 207) breast cancer were identified. 38 stage O and 103 stage I patients had evaluable PROs on the same day a recommendation for adjuvant hormone therapy was made. Overall 18/38 (47.4%) of stage 0 patients and 90 of 103 (87.4%) of stage I patients accepted adjuvant treatment. Stage 0 patients declining adjuvant therapy reported any grade of PROs: DS (40%, n = 8), F (35%, n = 7), M (35%, n = 7), P (20%, n = 4). Stage 0 patients accepting treatment reported: DS (22%, n = 4), F (44%, n = 8), M (6%, n = 1), P (20%, n = 4). Stage I patients who declined treatment reported: DS (54%, n = 7), F (46%, n = 6), M (38%, n = 5), P (62%, n = 8). Stage I patients accepting treatment reported: DS (41%, n = 37), F (49%, n = 44), M (31%, n = 28), P (36%, n = 32). Conclusions: Early stage breast cancer patients declining adjuvant hormone therapy are more likely to self report symptoms such as difficulty sleeping, mood disturbances (anxiety, depression), and pain than those accepting treatment.

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Ligibel, Jennifer A., and Eric P. Winer. "The Aromatase Inhibitors as Adjuvant Therapy for Hormone Receptor-Positive Breast Cancer." Journal of the National Comprehensive Cancer Network 1, no. 2 (April 2003): 215–21. http://dx.doi.org/10.6004/jnccn.2003.0020.

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Adjuvant hormonal therapy has been shown to decrease the risk of breast cancer recurrence and overall mortality in patients with hormone receptor-positive breast cancer. Tamoxifen has been used in this setting for many years, both in premenopausal and postmenopausal patients. Tamoxifen is not devoid of toxicity, and attempts have been made to develop newer hormonal agents with better efficacy and less toxicity. The aromatase inhibitors have shown equivalent or superior efficacy to tamoxifen in the treatment of metastatic breast cancer, and efforts are underway to determine the role of these agents in early breast cancer. The ATAC trial recently showed that use of the third-generation aromatase inhibitor anastrozole in the adjuvant setting led to a modest improvement in relapse-free survival as compared with tamoxifen. Patients treated with anastrozole were also less likely to develop uterine cancer or experience a thromboembolic event. However, patients treated with anastrozole were more likely than those treated with tamoxifen to suffer a fracture or other musculosketal problem. An ASCO technology assessment panel reviewed the relevant data and issued a consensus statement regarding the use of aromatase inhibitors in the adjuvant setting. In general, the panel favored the continued use of tamoxifen as adjuvant hormonal therapy for most postmenopausal women. Within the next few years, further data from the ATAC trial and from other trials of aromatase inhibitors in the adjuvant setting should be available to guide treatment recommendations for this patient population.

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Love, Richard R., Nguyen Ba Duc, D. Craig Allred, Nguyen Cong Binh, Nguyen Van Dinh, Nguyen Ngoc Kha, Tran Van Thuan, et al. "Oophorectomy and Tamoxifen Adjuvant Therapy in Premenopausal Vietnamese and Chinese Women With Operable Breast Cancer." Journal of Clinical Oncology 20, no. 10 (May 15, 2002): 2559–66. http://dx.doi.org/10.1200/jco.2002.08.169.

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PURPOSE: In 1992, the Early Breast Cancer Trialists’ Collaborative Group reported that a meta-analysis of six randomized trials in European and North American women begun from 1948 to 1972 demonstrated disease-free and overall survival benefit from adjuvant ovarian ablation. Approximately 350,000 new cases of breast cancer are diagnosed annually in premenopausal Asian women who have lower levels of estrogen than western women. PATIENTS AND METHODS: From 1993 to 1999, we recruited 709 premenopausal women with operable breast cancer (652 from Vietnam, 47 from China) to a randomized clinical trial of adjuvant oophorectomy and tamoxifen (20 mg orally every day) for 5 years or observation and this combined hormonal treatment on recurrence. At later dates estrogen- and progesterone-receptor protein assays by immunohistochemistry were performed for 470 of the cases (66%). RESULTS: Treatment arms were well balanced. With a median follow-up of 3.6 years, there have been 84 events and 69 deaths in the adjuvant treatment group and 127 events and 91 deaths in the observation group, with 5-year disease-free survival rates of 75% and 58% (P = .0003 unadjusted; P = .0075 adjusted), and overall survival rates of 78% and 70% (P = .041 unadjusted) for the adjuvant and observation groups, respectively. Only patients with hormone receptor–positive tumors benefited from the adjuvant treatment. In Vietnam, for women unselected for hormone receptor status, a cost-effectiveness analysis suggests that this intervention costs $350 per year of life saved. CONCLUSION: Vietnamese and Chinese women with hormone receptor–positive operable breast cancer benefit from adjuvant treatment with surgical oophorectomy and tamoxifen.

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27

Winer, Eric P., Clifford Hudis, Harold J. Burstein, Antonio C. Wolff, Kathleen I. Pritchard, James N. Ingle, Rowan T. Chlebowski, et al. "American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor–Positive Breast Cancer: Status Report 2004." Journal of Clinical Oncology 23, no. 3 (January 20, 2005): 619–29. http://dx.doi.org/10.1200/jco.2005.09.121.

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Purpose To update the 2003 American Society of Clinical Oncology technology assessment on adjuvant use of aromatase inhibitors. Recommendations Based on results from multiple large randomized trials, adjuvant therapy for postmenopausal women with hormone receptor–positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumor recurrence. Neither the optimal timing nor duration of aromatase inhibitor therapy is established. Aromatase inhibitors are appropriate as initial treatment for women with contraindications to tamoxifen. For all other postmenopausal women, treatment options include 5 years of aromatase inhibitors treatment or sequential therapy consisting of tamoxifen (for either 2 to 3 years or 5 years) followed by aromatase inhibitors for 2 to 3, or 5 years. Patients intolerant of aromatase inhibitors should receive tamoxifen. There are no data on the use of tamoxifen after an aromatase inhibitor in the adjuvant setting. Women with hormone receptor–negative tumors should not receive adjuvant endocrine therapy. The role of other biomarkers such as progesterone receptor and HER2 status in selecting optimal endocrine therapy remains controversial. Aromatase inhibitors are contraindicated in premenopausal women; there are limited data concerning their role in women with treatment-related amenorrhea. The side effect profiles of tamoxifen and aromatase inhibitors differ. The late consequences of aromatase inhibitor therapy, including osteoporosis, are not well characterized. Conclusion The Panel believes that optimal adjuvant hormonal therapy for a postmenopausal woman with receptor-positive breast cancer includes an aromatase inhibitor as initial therapy or after treatment with tamoxifen. Women with breast cancer and their physicians must weigh the risks and benefits of all therapeutic options.

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He, Wei, Fang Fang, Catherine Varnum, Mikael Eriksson, Per Hall, and Kamila Czene. "Predictors of Discontinuation of Adjuvant Hormone Therapy in Patients With Breast Cancer." Journal of Clinical Oncology 33, no. 20 (July 10, 2015): 2262–69. http://dx.doi.org/10.1200/jco.2014.59.3673.

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Purpose To identify predictors of discontinuation of adjuvant hormone therapy in patients with breast cancer. Patients and Methods We conducted a record-linkage study based on data from Stockholm-Gotland Breast Cancer Register, Swedish Prescribed Drug Register, and self-reported questionnaire. Women diagnosed with breast cancer between 2005 and 2008 in Stockholm, Sweden, were prospectively followed for 5 years until 2013, starting from their first prescription of tamoxifen or aromatase inhibitors (N = 3,395). Results Family history of ovarian cancer (hazard ratio [HR], 1.55; 95% CI, 1.19 to 2.02); younger (< 40 years; HR, 1.39; 95% CI, 1.08 to 1.78) and older (≥ 65 years; HR, 1.15; 95% CI, 1.03 to 1.28) age; higher Charlson comorbidity index (≥ 2 v 0; HR, 1.35; 95% CI, 1.03 to 1.76); and use of analgesics (HR, 1.33; 95% CI, 1.16 to 1.52), hypnotics/sedatives (HR, 1.24; 95% CI, 1.07 to 1.43), GI drugs (HR, 1.25; 95% CI, 1.08 to 1.43), and hormone replacement therapy (HR, 1.27; 95% CI, 1.08 to 1.49) were identified as baseline predictors for hormonal treatment discontinuation. Use of analgesics (HR, 1.22; 95% CI, 1.08 to 1.37), hypnotics/sedatives (HR, 1.21; 95% CI, 1.07 to 1.37), antidepressants (HR, 1.22; 95% CI, 1.06 to 1.40), or GI drugs (HR, 1.27; 95% CI, 1.13 to 1.43), and switching therapy between tamoxifen and aromatase inhibitors (HR, 1.50; 95% CI, 1.23 to 1.83) during the first year of hormonal treatment were associated with increased risk of discontinuation during the next 4 years. Conclusion Predictors identified in our study can be used in developing targeted intervention to prevent adjuvant hormone therapy discontinuation and subsequently to improve breast cancer outcomes.

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Lin, C. M., J. Jaswal, T. Vandenberg, A. Tuck, and M. Brackstone. "Weakly hormone receptor– positive breast cancer and use of adjuvant hormonal therapy." Current Oncology 20, no. 6 (September 16, 2013): 612. http://dx.doi.org/10.3747/co.20.1598.

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Gnant, Michael, Catherine Van Poznak, and Lowell Schnipper. "Therapeutic Bone-Modifying Agents in the Nonmetastatic Breast Cancer Setting: The Controversy and a Value Assessment." American Society of Clinical Oncology Educational Book, no. 37 (May 2017): 116–22. http://dx.doi.org/10.1200/edbk_177357.

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Clinical trials and meta-analyses investigating bisphosphonates as an adjuvant breast cancer therapy have shown a consistent trend, with postmenopausal women and women receiving ovarian suppression with gonadotropin-releasing hormone therapy gaining improved breast cancer outcomes with the use of adjuvant bisphosphonate therapy. The interpretation of these data is controversial, because the primary endpoints of the majority of adjuvant bisphosphonate studies have been negative. Pros and cons as well as the value of adjuvant bisphosphonate therapy are discussed here.

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Strasser-Weippl, Kathrin, and Paul E. Goss. "Adjuvant endocrine therapy options in hormone-dependent breast cancer." European Journal of Cancer Supplements 3, no. 3 (October 2005): 247–54. http://dx.doi.org/10.1016/s1359-6349(05)80281-2.

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Ovcaricek, Tanja, Iztok Takac, and Erika Matos. "Multigene expression signatures in early hormone receptor positive HER 2 negative breast cancer." Radiology and Oncology 53, no. 3 (September 24, 2019): 285–92. http://dx.doi.org/10.2478/raon-2019-0038.

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Abstract Background The standard treatment of hormone receptor positive, HER2 negative early breast cancer (BC) is surgery followed by adjuvant systemic therapy either with endocrine therapy alone or with the addition of chemotherapy followed by endocrine therapy. Adjuvant systemic therapy reduces the risk of recurrence and death from BC. Whether an individual patient will benefit from adjuvant chemotherapy is an important clinical decision. Decisions that rely solely on clinical-pathological factors can often lead to overtreatment. Multigene signatures represent an important progress in optimal selection of high risk patients that might benefit from the addition of chemotherapy to adjuvant endocrine therapy. Conclusions Several signatures are already commercially available and also accepted by international guidelines. Oncotype DX and MammaPrint have been most extensively validated and supported by level IA evidence.

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Chia, S. K. L. "Clinical application and utility of genomic assays in early-stage breast cancer: key lessons learned to date." Current Oncology 25 (June 14, 2018): 125. http://dx.doi.org/10.3747/co.25.3814.

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Early-stage hormone receptor–positive breast cancer is the most common subtype and stage presenting in countries with organized screening programs. Standard clinical and pathologic factors are routinely used to support prognosis and decisions about adjuvant therapies. Hormone receptor and her2 status are essential for decision-making about the use of adjuvant hormonal and anti-her2 therapies respectively. Genomic assays are now commercially available to aid in either further prognostication or in refining the potential benefit of adjuvant chemotherapy. The current genomic assays all generally quantify estrogen receptor and proliferation gene sets (among others) by rna expression, although the specific genes assayed are quite discordant. The present review focuses on the pivotal studies in which each assay attempted to demonstrate clinical utility, with an emphasis on prospective trial data for each assay, if available. Using genomic assays, health care providers will increasingly be able to individualize therapy or de-escalate therapy, optimizing clinic benefit while minimizing toxicities from systemic therapies.

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Greene, Rebecca E., and Vivian Tsang. "Hormonal Therapy for the Treatment of Postmenopausal Breast Cancer Patients." Journal of Pharmacy Practice 21, no. 1 (February 2008): 36–45. http://dx.doi.org/10.1177/0897190008315055.

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Breast cancer is the most common cancer diagnosed and the second leading cause of cancer-related death in women. The majority of breast cancers diagnosed in postmenopausal women are hormone receptor positive and involve therapy with hormonal agents. Tamoxifen, a selective estrogen-receptor modulator, has been the mainstay of hormonal therapy since the 1970s. The more recent approval and success of aromatase inhibitors, such as anastrozole, letrozole, and exemestane, have seen these agents move to the front line of therapy for postmenopausal women with hormone-positive breast cancer in the adjuvant and metastatic settings. Fulvestrant, a selective estrogen receptor— downregulator, provides an additional hormonal therapy with a novel mechanism of action. This article reviews the current literature available regarding the use of these agents for postmenopausal women with early stage or advanced breast cancer.

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Mori, Ryutaro, and Yasuko Nagao. "The efficacy of second-line hormone therapy for recurrence during adjuvant hormone therapy for breast cancer." Therapeutic Advances in Medical Oncology 6, no. 2 (January 13, 2014): 36–42. http://dx.doi.org/10.1177/1758834013517734.

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Svahn, Tiffany H., and Robert W. Carlson. "Modest benefits of adjuvant chemotherapy in hormone receptor-positive breast cancer." Breast Cancer Online 9, no. 7 (May 16, 2006): 1–4. http://dx.doi.org/10.1017/s1470903106004378.

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The benefits of adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy are well-established in patients with early breast cancer. Further, there are patient and tumor characteristics that can assist in predicting which patients are more likely to benefit from specific adjuvant therapies. For example, patients whose tumors express estrogen and/or progesterone receptors (ER/PR) derive significant benefit from adjuvant endocrine therapy, whereas those whose tumors do not express these receptors derive very little or no benefit from endocrine therapy [1]. Patients whose tumors overexpress HER2 experience profound benefits from treatment with adjuvant trastuzumab [2,3]. We have recently begun to understand that ER/PR-positive breast cancer also responds differently to chemotherapy than its hormone receptor-negative counterpart. This is not, however, entirely new information. As early as 1978, it was retrospectively observed that ER-positive metastatic breast cancer had lower response rates to a variety of older chemotherapy regimens than did ER-negative disease [4].

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Bracken-Clarke, Dara B., Mairi W. Lucas, and Michaela J. Higgins. "Extended Adjuvant Endocrine Therapy in Hormone Receptor-Positive Early Breast Cancer." Breast Care 12, no. 3 (2017): 138–44. http://dx.doi.org/10.1159/000477956.

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Despite meaningful, incremental improvements in detection, local treatment and adjuvant systemic treatments for breast cancer, there remains a significant risk of late relapse in hormone receptor (HR)-positive disease. 5 years of tamoxifen or an aromatase inhibitor for all patients with HR-positive early breast cancer is considered standard; however, there are now data to support an extended approach using up to 10 years of treatment. This review will provide some historical background on endocrine therapy and summarize the key clinical trials that demonstrate the small absolute benefit of extended adjuvant therapy. We provide suggested treatment algorithms for both premenopausal and postmenopausal patients and an overview of ongoing adjuvant trials.

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Varnier, Romain, Christophe Sajous, Solène de Talhouet, Colette Smentek, Julien Péron, Benoît You, Thibaut Reverdy, and Gilles Freyer. "Using Breast Cancer Gene Expression Signatures in Clinical Practice: Unsolved Issues, Ongoing Trials and Future Perspectives." Cancers 13, no. 19 (September 28, 2021): 4840. http://dx.doi.org/10.3390/cancers13194840.

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The development of gene expression signatures since the early 2000′s has offered standardized assays to evaluate the prognosis of early breast cancer. Five signatures are currently commercially available and recommended by several international guidelines to individualize adjuvant chemotherapy decisions in hormone receptors-positive/HER2-negative early breast cancer. However, many questions remain unanswered about their predictive ability, reproducibility and external validity in specific populations. They also represent a new hope to tailor (neo)adjuvant systemic treatment, adjuvant radiation therapy, hormone therapy duration and to identify a subset of patients who might benefit from CDK4/6 inhibitor adjuvant treatment. This review will highlight these particular issues, address the remaining questions and discuss the ongoing and future trials.

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Adami, G., A. Fassio, A. Giollo, G. Orsolini, O. Viapiana, D. Gatti, and M. Rossini. "SAT0456 REAL-LIFE RISK OF FRACTURE AND TREATMENT PREVALENCE IN DRUG-INDUCED OSTEOPOROSIS IN ITALY USING A NEW ALGORITHM." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1185.1–1186. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2565.

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Background:Glucocorticoid-induced osteoporosis and osteoporosis induced by adjuvant hormone therapy for breast cancer are the most common forms of secondary osteoporosis.Objectives:The exact real-life prevalence of treatment with anti-osteoporotic drugs in women with drug-induced osteoporosis is not known. In the present study, using a new mathematical and computerized algorithm, we investigate the profile of risk of fracture of women with drug-induced osteoporosis and the prevalence of treatment with anti-osteoporotic drugs.Methods:We have retrospectively analyzed the 10-year risk of major osteoporotic fracture calculated with the DeFRAcalc79 tool in postmenopausal women aged over 50 years that were initiating an anti-osteoporotic treatment (fully reimbursed according to the Nota 79). DeFRAcalc79 is a new web-based fracture risk-assessment tool (https://defra-osteoporosi.it) that arithmetically adjusts the risk based on multiple risk factors contemplated by the Nota 79, which regulates the reimbursability for osteoporosis medications in Italy (Italian Agency for Drugs, AIFA), including demographic and anthropometric data, femoral and/or lumbar spine BMD T-score, family history of femoral or vertebral fractures, number and site of previous osteoporotic fracture (including vertebral, femoral, and non-vertebral non-femoral fractures), glucocorticoid treatment (> 3 or > 12 months, ≥5 mg prednisone or equivalent), adjuvant hormone therapy for breast cancer, and comorbidities that induce an increased risk of fracture (rheumatoid arthritis and other connective tissue diseases, chronic obstructive pulmonary disease, inflammatory bowel diseases, Parkinson’s disease, multiple sclerosis, human immunodeficiency virus infection, diabetes, or severe physical handicap). This is a sub-analysis of the cross-sectional observational study to validate and further develop the DeFRA algorithm for the estimation of the risk of osteoporotic fractures, promoted by Verona hospital with the unconditional support of Amgen Srl.Results:Among 208 women, 116 (55.8%) were treated with adjuvant hormone therapy for breast cancer and 92 (44.2%) were on glucocorticoid ≥5 mg/day. Women on glucocorticoids had a greater mean 10-year risk of fracture compared to women on adjuvant hormone therapy for breast cancer (67.0% vs 39.1% p<0.01). 50.7% of women on adjuvant hormone therapy for breast cancer used denosumab, 28.0% zoledronic acid and 17.3% alendronate. In glucocorticoid-induced osteoporosis, 17.6% of the women used teriparatide, 37.3% alendronate, 29.4% zoledronic acid and 13.7% denosumab.Conclusion:In our cohort of patients, treatment with adjuvant hormone therapy for breast cancer was slightly more common than glucocorticoids. Women with glucocorticoid-induced osteoporosis had a greater risk of fracture compared to patients treated with adjuvant hormone therapy for breast cancer. Half of the patients on adjuvant hormone therapy for breast cancer were prescribed with denosumab. One-fifth of the patients with glucocorticoid-induced osteoporosis was treated with teriparatide. DeFRAcalc79 is a useful and practical tool for the integrated evaluation of fracture risk in drug-induced osteoporosis.Disclosure of Interests:Giovanni Adami: None declared, Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work., Alessandro Giollo: None declared, Giovanni Orsolini: None declared, Ombretta Viapiana: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB

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Semiglazov, V. F., V. Yu Lifanova, and V. S. Appolonova. "Adjuvant therapy in premenopausal women with hormone-dependent breast cancer." Medical Council, no. 19 (November 11, 2018): 73–75. http://dx.doi.org/10.21518/2079-701x-2018-19-73-75.

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In recent years, several studies have indicated that aromatase inhibitors (AIS) combined with a gonadotropin-releasing hormone agonist (GnRH agonist) are safe and effective in premenopausal patients with hormone receptor positive (HR+) breast cancer (BCA). The ABCSG-12 trial has shown a comparable DFS for 3-eyar adjuvant therapy with anastrazol-goserelin and tamoxifengoserelin. However a combined analysis of the data from SOFT and TEXT trials demonstrated that compared with tamoxifen plus ovarian suppression, adjuvant endocrine therapy with exemestane plus GnRH agonist (Triptorelin) in premenopausal patients with a significant improved DFS and an extended interval without distant recurrence. The differing results emerging from ABCSG-12 and the TEXT and SOFT trials misht be related to higher statistical power in the combined analysis.

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Shukurov, Farkhad I., and Farida M. Aiupova. "Role of adjuvant hormonal therapy in restoring reproductive function in women after endosurgical treatment of ovarian follicular cysts." Gynecology 23, no. 1 (March 21, 2021): 68–72. http://dx.doi.org/10.26442/20795696.2021.1.200441.

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In the structure of the causes of female infertility, follicular ovarian cysts make up 710% of cases. Despite the studies on the reproductive health of women undergoing endosurgical treatment of follicular ovarian cysts, the problem of restoring reproductive function has not yet been resolved. Aim. To assess the effectiveness of a preparation containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts. Materials and methods. The study group included 100 women, of whom 70 patients (the main group) received adjuvant therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate after endosurgery, and a comparison group of 30 patients who did not receive adjuvant therapy. The diagnosis of follicular ovarian cysts was established on the basis of hormonal, ultrasound, endoscopic and immunohistochemical studies. The levels of gonadotropic hormones (LH, FSH), steroid hormones estradiol and progesterone were determined twice at the beginning of the follicular (35 day) and secretory phase (2022 day) of the menstrual cycle. An ovarian ultrasound was performed at the beginning of the follicular phase and on days 2022 of the menstrual cycle. Immunohistochemical studies of estrogen and progesterone receptors in the ovaries were carried out using a Bond-max immunostimulator from Leica (Germany) using monoclonal antibodies: clone 1D5 and clone 1A6 Dako (USA). Results. Menstrual irregularities were detected in 36 (51.4%) patients, of which: irregular menstruation in 18.0%, algomenorrhea in 15.1%, polymenorrhea in 11.0%, and menorrhea in 7.3% of patients, infertility was observed in 34 (48.6%) patients. Endosurgical treatment of follicular ovarian cysts was performed for all examined patients. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate was received by 70 patients. Menstrual function was restored in 70 (100%) patients. Pregnancy occurred in 60 (86.0%) of them. Conclusion. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate allowed to restore menstrual function (100% of cases), pregnancy at 4.3 times (86.0% of cases), which confirms its high efficiency in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

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Sundar, Santhanam, and Micheal Ocathail. "Adjuvant Hormone Therapy After Prostate Radiation: Is This Data Torture?" Journal of Clinical Oncology 39, no. 20 (July 10, 2021): 2314–15. http://dx.doi.org/10.1200/jco.21.00013.

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Hedin, T., C. Guo, and A. Nattinger. "Persistence with adjuvant hormone therapy in older breast cancer survivors." Journal of Clinical Oncology 29, no. 15_suppl (May 20, 2011): 6032. http://dx.doi.org/10.1200/jco.2011.29.15_suppl.6032.

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Liu, Feng, Daju Sun, Xueying Zhou, Youpeng Ding, Yanan Ma, Yi Hou, Xiangbo Kong, and Zhixin Wang. "Effect of adjuvant hormone therapy in patients with prostate cancer." Medicine 97, no. 50 (December 2018): e13145. http://dx.doi.org/10.1097/md.0000000000013145.

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Strasser-Weippl, Kathrin, Tanja Badovinac-Crnjevic, Lei Fan, and Paul E. Goss. "Extended adjuvant endocrine therapy in hormone-receptor positive breast cancer." Breast 22 (August 2013): S171—S175. http://dx.doi.org/10.1016/j.breast.2013.07.033.

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Eeles, Rosalind A., James P. Morden, Martin Gore, Janine Mansi, John Glees, Miklos Wenczl, Christopher Williams, et al. "Adjuvant Hormone Therapy May Improve Survival in Epithelial Ovarian Cancer." Obstetrical & Gynecological Survey 71, no. 4 (April 2016): 223–24. http://dx.doi.org/10.1097/ogx.0000000000000308.

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Kilickap, Saadettin, and Deniz Tural. "Does Adjuvant Hormone Therapy Improve Survival in Epithelial Ovarian Cancer?" Journal of Clinical Oncology 34, no. 17 (June 10, 2016): 2069. http://dx.doi.org/10.1200/jco.2015.65.3683.

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Hershman, Dawn L., Lawrence H. Kushi, Theresa Shao, Donna Buono, Aaron Kershenbaum, Wei-Yann Tsai, Louis Fehrenbacher, Scarlett Lin Gomez, Sunita Miles, and Alfred I. Neugut. "Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients." Journal of Clinical Oncology 28, no. 27 (September 20, 2010): 4120–28. http://dx.doi.org/10.1200/jco.2009.25.9655.

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Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

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Montemurro, Filippo, and Massimo Aglietta. "Hormone receptor-positive early breast cancer: controversies in the use of adjuvant chemotherapy." Endocrine-Related Cancer 16, no. 4 (December 2009): 1091–102. http://dx.doi.org/10.1677/erc-09-0033.

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Current adjuvant treatments for operable breast cancer include chemotherapy, endocrine therapy in hormone receptor-positive tumors, and trastuzumab for HER2-positive tumors. Metanalyses of randomized trials show that in patients with hormone receptor-positive breast cancer, the effects of endocrine therapy and chemotherapy on survival are non-mutually exclusive. Most of these patients are therefore considered candidates to combined treatment. Recently, however, the endocrine responsiveness of tumors has been redefined on clinical, histopathological, and molecular bases. An emerging concept is that as endocrine responsiveness increases, chemoresponsiveness decreases. In the adjuvant setting, therapeutic choices are often based on small projected improvements in clinical outcomes. As a consequence, the role of chemotherapy and traditional management algorithms in patients with hormone receptor positive is being challenged. This review will address the current controversy regarding the role of adjuvant chemotherapy, including the newer anthracycline and taxane-based programs, in these patients.

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Angelopoulos, N., V. Barbounis, S. Livadas, D. Kaltsas, and G. Tolis. "Effects of estrogen deprivation due to breast cancer treatment." Endocrine-Related Cancer 11, no. 3 (September 2004): 523–35. http://dx.doi.org/10.1677/erc.1.00783.

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Breast cancer is one of the main life-threatening diseases that a woman may have to face during her lifetime. The increasing incidence of breast neoplasia reported over the last few decades has led to widespread screening of women resulting in early diagnosis. One common but challenging question for most doctors, after the surgical excision of the lesion, is determination of the ideal adjuvant therapy for their patients for the achievement of maximum life expectancy with the best quality of life. Since the beginning of the last century, the knowledge that breast cancer arises from hormone-responsive tissues has long made use of hormone-blocking agents in the beneficial treatment of breast neoplasia. The discovery of new molecules with endocrine actions has rendered the use of adjuvant therapy in a tailor-made pattern too complicated, as these agents have a different mode of action, different adverse effects and probably different indications. The aim of the present review is to clarify these issues, analyzing the mechanism of action of available drugs and their actions on specific areas of uncertainty: cognitive function, cardiovascular system, urogenital tract, bone metabolism, weight gain, hot flushes and premature menopause. Regarding the efficacy of adjuvant therapy, there has been particular focus on the multiple hormonal-induced consequences of each regimen in order to provide the clinician with the available data for choosing the ideal therapy for the patient.

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