Several adjuvant endocrine therapy options are available for premenopausal patients with endocrine-responsive early-stage breast cancer. It can be a challenge, however, when deciding which option is optimal for a specific patient. Thanks to improved medical therapies, a substantial proportion of premenopausal women with early-stage breast cancer can achieve excellent outcomes with endocrine therapy only, and can avoid chemotherapy, according to medical oncologist Hatem A. Azim Jr, MD, PhD, of the Institut Jules Bordet in Belgium.
Dr Azim, who presented an overview on the challenges of treating premenopausal women with endocrine-sensitive breast cancer at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting, said it is time to challenge the notion that adjuvant chemotherapy should be considered in all young women with breast cancer.1 He said recent evidence from randomized trials indicates that it may possible for select women to avoid adjuvant chemotherapy.
“Considering both aspects of the disease itself and quality of life issues is not an easy task. In a lot of cases, it’s a thin line that we have to preserve, but is vital in my view to stand up to the aspirations of our patients,” Dr Azim told Cancer Therapy Advisor.
He said options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression plus tamoxifen for 5 years, and ovarian function suppression plus an aromatase inhibitor for 5 years. There are rather modest differences in efficacy among these regimens, though there is a clear benefit with ovarian function suppression, mostly for patients with higher-risk disease.
Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility; all of these side effects can impair quality of life and affect treatment compliance. Ovarian function suppression tends to worsen menopausal side effects and hot flashes tend to be worse with tamoxifen/ovarian function suppression. Sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/ovarian function suppression.