Adjuvant Endocrine Therapy for Hormone-positive Breast Cancer, Focusing on Ovarian Suppression and Extended Treatment: An Update

The benefits of five years of adjuvant endocrine therapy for oestrogen receptor (ER)-positive early breast cancer are well established. However, recent evidence suggests that extended endocrine treatment and ovarian suppression in selected groups of patients have significant advantages. In this article, we review the current evidence for adjuvant endocrine therapy in breast cancer with focus on extended adjuvant endocrine therapy and ovarian suppression, and also highlight the advantages and disadvantages of these therapeutic strategies. A literature search was performed through PubMed, Medline, and Cochrane using the following search terms: Endocrine therapy, Tamoxifen, Anastrazole, Ovarian Suppression, Exemestane, Letrozole and STS Inhibitors. All available evidence for adjuvant endocrine therapy was reviewed and summarised to assess the current guidance and the progress of the management of patients with ER-positive breast cancer. Extended endocrine therapy should be tailored according to patient needs dictated by their individual risk factors, molecular type of breast cancer, menopausal status, comorbidities, life style and risk of recurrence. Clinicians ought to discuss with patients the pros and cons of different adjuvant endocrine therapy approaches and highlight the potential side effects and toxicity.