Michael Savin, MD
Upwards of 70% of all breast cancers express estrogen receptors (ERs) or progesterone receptors (PRs), categorizing them as receptor-positive cancers. All patients with these hormone receptor (HR)-positive breast cancers can be considered for adjuvant treatment with endocrine therapy, said Michael A. Savin, MD.
State of the Science Summit™ on Breast Cancer, Savin, clinical medical director, Oregon Health and Science University Knight Cancer Institute, shared his insight on adjuvant endocrine therapy for premenopausal women with HR-positive breast cancer.
Use of Tamoxifen
Tamoxifen is the treatment of choice for patients with standard-risk premenopausal breast cancer, Savin said. This agent has been in use since the 1970s and is one of the cheapest options available, costing uninsured patients to per month. It remains a dominant drug in this setting.
There appears to be additional benefit with aromatase inhibitors with ovarian suppression in premenopausal women who are considered high risk, Savin said. This is based on several factors including the intrinsic aggressiveness of the cancer, the presence of nodal metastases, and tumor size.
After 5 years of adjuvant tamoxifen, there are several options. In patients who become postmenopausal and are treated after 50 years of age, the treating physician can switch the patient to an aromatase inhibitor like in the MA.17 trial, or they can continue giving tamoxifen as an option if an aromatase inhibitor is not acceptable or tolerated. Tamoxifen can also be extended to 10 years if a patient remains premenopausal, or discontinuing endocrine therapy after 5 years of tamoxifen if the patient tolerated tamoxifen poorly.
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