Is Endocrine Therapy Really Pleasant? Considerations about the Long-Term Use of Antihormonal Therapy and Its Benefit/Side Effect Ratio

Breast care

Peter Panhofer¹  Michael Gnant¹  Ursula Pluschnig¹  Thomas Bachleitner-Hofmann¹  Guenther Steger¹  Sinda Bigenzahn¹  Ruth Exner¹  Andrea Dal Borgo¹  Sebastian Schoppmann¹  Emanuel Sporn¹  Otto Riedl¹  Florian Fitzal¹  Peter Dubsky¹  Peter Blaha¹  Raimund Jakesz¹ 

[1] Department of Surgery, Medical University of Vienna, Austria

关键词: Endocrine therapy;    Breast cancer;    Tamoxifen;    Aromatase inhibitors;    Anastrozole;    Letrozole;    Exemestane;    Side effects;    Tolerability;    Safety;   

DOI  :  10.1159/000227829

学科分类：泌尿医学

来源: S Karger AG

【 摘 要 】

Endocrine therapy has become a key part in the adjuvant treatment of hormone responsive breast cancer. The positive effect on relapse risk reduction is well defined, but therapy is not free from bothersome side effects for which estrogen deprivation accounts to a great extent. Since endocrine therapy is usually prescribed for 5 years or longer to optimally display its protective effect, and because physical strain is missing, good tolerability and safety properties are important, particularly in low-risk patients. While tamoxifen has been the standard adjuvant endocrine treatment with well documented efficiency, it is increasingly replaced by third generation aromatase inhibitors due to their better effectiveness and tolerability. Because tamoxifen holds a risk for life-threatening adverse events such as endometrial cancer, pulmonary embolism, and stroke, its recommended duration of therapy is limited to 5 years, also because extension beyond that time did not produce a measurable advantage. While some side effects are present both with tamoxifen and aromatase inhibitors, differences in side effect profiles are well established. Although side effects of aromatase inhibitor-related therapy usually are mild and common to symptoms of menopause, misconception of the symptoms and their mechanism of action, as well as lack of knowledge about how to handle them, can easily lead to dangerous discontinuation of therapy.

【 授权许可】

Unknown