Adjuvant hormonotherapy in breast cancer - is "the option zero" realistic?

Adjuvant hormonal therapy increases disease free interval and overall survival, reduces risk of distant metastases and second breast cancer in patients with hormone-sensitive early breast cancer. Documented clinical advantage of aromatase inhibitors led to numerous trials on the use of this class of agents in the adjuvant setting for postmenopausal women. Based on the results of these trials sufficient data exist to consider sequential hormonotherapy, although there are still some not resolved elements of this strategy. Primary adjuvant hormonotherapy with aromatase inhibitors seems to be limited to patients in whom tamoxifen is contraindicated or not tolerated. Expert panels advise to be cautious and potential guidelines modifications should be based on the final results of current studies with clarification of all controversial issues. At present, the results of several studies on the use of hormonal adjuvant therapy in premenopausal women are available and they give some evidence to switch for hormonal therapy and gonadoliberin analogues in the adjuvant setting. More data are necessary to establish optimal time framework for adjuvant hormonotherapy. Launching new drugs in adjuvant breast cancer therapy may require revision of current treatment guidance. The future adjuvant therapy may be much more tailored based on individual genetic profile derived from microarrays study.