Tripathy D, Im SA, Colleoni M, et al. Aromatase inhibitors The aromatase inhibitor anastrozole is a reasonable alternative to tamoxifen in postmenopausal women with ER-positive DCIS. Aromatase inhibitors block the enzyme aromatase, which turns other hormones into estrogen. Induction endocrine therapy (tamoxifen with or without aromatase inhibitors) is less effective than chemotherapy and may be most appropriate for older patients not willing to accept chemotherapy-related toxicity. Five-year survival is attained in only 23.3 percent of these patients3; therefore, it is important to understand the patients treatment goals. You notice changes in your body that may be symptoms of recurrent breast cancer. In the clinical trial, called MONALEESA-2, women treated with the CDK4/6 inhibitor ribociclib (Kisqali) and the hormone-blocking drug letrozole (Femara) as their initial treatment for advanced breast cancer lived approximately 1 year longer overall than women treated with letrozole alone . and without (1.7% . MONARCH 2: Abemaciclib in combination with fulvestrant in women with HR+/HER2- advanced breast cancer who had progressed while receiving endocrine therapy. Endocrine therapies, such as SERMs, aromatase inhibitors, and gonadotropin-releasing hormone agonists, prevent estrogen production or block estrogen, thereby preventing stimulation of an estrogen-sensitive tumor. Some people may find it difficult to tolerate the possible side effects. 25(19):2664-70, 2007. Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone (9). 386(10001):1341-52, 2015. Dickler MN, Tolaney SM, Rugo HS, et al. Intent-to-treat analysis of the placebo-controlled trial of letrozole for extended adjuvant therapy in early breast cancer: NCIC CTG MA.17. Hormone therapy also may disrupt the menstrual cycle in premenopausal women. Hur G, et al. Eur J Cancer. Rudlowski C. Male breast cancer. The aromatase inhibitors anastrozole and letrozole are approved to be given to postmenopausal women as initial therapy for metastatic or locally advanced hormone-sensitive breast cancer (12, 13). Providers use aromatase inhibitor therapy as front-line or initial treatment for ER-positive breast cancer. Modified radical mastectomy has traditionally been the standard of care for early-stage invasive breast cancers. Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive (3). Aromatase inhibitors (AIs) lower estrogen levels by stopping an enzyme in fat tissue (called aromatase) from changing other hormones into estrogen. Hormone therapy (also called hormonal therapy, hormone treatment, or endocrine therapy) slows or stops the growth of hormone-sensitive tumors by blocking the body's ability to produce hormones or by interfering with effects of hormones on breast cancer cells. In patients with LABC and clinically negative nodes, SLN biopsy following induction chemotherapy has been shown to have a similar detection rate as in early-stage breast cancer without induction chemotherapy.20 Even in patients who have clinically complete remission with induction chemotherapy, radiation therapy following surgery decreases the local recurrence rate.55. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information. Last reviewed by a Cleveland Clinic medical professional on 02/03/2023. Breast cancer is the second most common cause of cancer mortality in women in the United States.1 One in eight women will be diagnosed in her lifetime.2 Breast cancer treatments continue to evolve, and although family physicians do not generally make primary decisions about these therapies, understanding their rationale and underlying evidence can help with the care of their patients during and after cancer treatment. Hormone therapy for breast cancer should not be confused with menopausal hormone therapy (MHT)treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. Anastrozole is cost-effective vs tamoxifen as initial adjuvant therapy in early breast cancer: Canadian perspectives on the ATAC completed-treatment analysis. They are typically treated with surgery and/or radiation and the 5-year survival rate is high (approximately 95%). Most people take aromatase inhibitors for five years, stopping treatment if they dont have signs of recurring or new breast cancer. Label: Arimidex- anastrozole tablet. Finally, some women may switch to an aromatase inhibitor after 2 or 3 years of tamoxifen, for a total of 5 or more years of hormone therapy. 2020 Jul;182(2):355-365. doi: 10.1007/s10549-020-05706-2. at the National Institutes of Health, An official website of the United States government, gonadotropin-releasing hormone (GnRH) agonist, luteinizing hormone-releasing hormone (LHRH) agonist, Selective estrogen receptor modulators (SERMs), U.S. Department of Health and Human Services, Some women with advanced breast cancer that is HER2 and HR positive may receive hormone therapy plus, bone loss in premenopausal women, but no increased risk of fracture. Lancet Oncology 2016; 17(4):425439. Manage your account, Given the appreciable late recurrence rates in women with ER-positive breast cancer . Palbociclib and letrozole in advanced breast cancer. J Clin Oncol. Stage III breast cancer typically requires induction chemotherapy to down-size the tumor to facilitate breast-conserving surgery. 2,3 Nevertheless, most patients have disease . Hormonal therapies for early breast cancer: systematic review and economic evaluation. Cleveland Clinic is a non-profit academic medical center. This enzyme plays a critical role in the body'suse of tamoxifenbecause CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself. Five-year survival can be achieved in 55 percent of patients presenting with noninflammatory LABC.54 The most important prognostic factors are response to induction chemotherapy and lymph node status. Sledge GW Jr, Toi M, Neven P, et al. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen. Jin H, Tu D, Zhao N, Shepherd LE, Goss PE. Aromatase inhibitors. Aromatase inhibitors are medications that help lower estrogen levels. Learn more about these side effects and how best to manage them. In patients with clinically negative nodes, a negative intraoperative sentinel lymph node (SLN) biopsy precludes the need for ALN dissection. Ann Oncol. (2015). If there is evidence of axillary involvement without distant metastases, axillary evaluation is recommended. 2021 Jul 20;39(21):2386-2396. doi: 10.1200/JCO.21.00831. Regan MM, Neven P, Giobbie-Hurder A, et al. However, the cancer returned in as many as 30 percent of people observed in the study. However, these drugs can be used in premenopausal women if they are given together with a drug that suppresses ovarian function. Radiation therapy following breast-conserving surgery decreases mortality and recurrence. Newly diagnosed breast cancer with low concentrations of these markers has such a low risk of recurrenceespecially in patients with hormone receptorpositive tumors receiving adjuvant endocrine therapythat chemotherapy may provide only minimal benefits.62, The Oncotype DX assay measures expression of 21 genes and predicts which patients with node-negative disease are less likely to benefit from chemotherapy.63 Biomarkers are also being developed to predict severe drug-related toxicity.63. Boccardo F, Guglielmini P, Bordonaro R, et al. (2021). Accessibility The absolute improvement was 4%. Aromatase inhibitors work by reducing the amount of estrogen in your body. Adjuvant hormonal therapy for early-stage breast cancer. (Women and people AFAB who havent gone through menopause typically dont receive aromatase inhibitor therapy because their ovaries are still making estrogen.). These women were included in the disease-free survival rates for those who took a placebo. 30(7):718-21, 2012. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: Patient-level meta-analysis of randomised trials. Please enable it to take advantage of the complete set of features! Journal of the National Cancer Institute 2015; 107(6):djv048. Locally advanced breast cancer (LABC) includes tumors larger than 5 cm, extensive regional lymph node involvement, direct involvement of underlying chest wall or skin, tumors considered inoperable but without distant metastases, and inflammatory breast cancer. Cancer 2005; 104(2):236239. Exemestane use in postmenopausal women at high risk for invasive breast cancer: Evaluating biomarkers of efficacy and safety. Patients and Methods Choice of adjuvant systemic therapy depends on lymph node involvement, hormone receptor status, ERBB2 (formerly HER2 or HER2/neu) overexpression, and patient age and menopausal status. Third-generation aromatase inhibitors (AIs) are the mainstay of treatment in hormone receptor (HR)-positive breast cancer. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Men with advanced breast cancer who are treated with an aromatase inhibitor also receive a GnRH agonist. Journal of the National Cancer Institute 1998; 90(18):13711388. Aromatase inhibitors are used to treat hormone-receptor positive breast cancers. Cuzick J, Sestak I, Baum M, et al. Cost-Effectiveness of Adjuvant Treatment for Ductal Carcinoma In Situ. AIs are effective in adjuvant and first-line metastatic setting. However, with the introduction of newer hormone therapies (i.e., the aromatase inhibitors), some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common (57). for monarchE in 10% for Verzenio plus tamoxifen or an aromatase inhibitor with a difference between arms of 2% were . If youre receiving treatment for ER-positive breast cancer, ask your healthcare provider to explain your risk of late recurrence breast cancer. Concerned about a red bump on your breast that looks like a pimple? Estrogen promotes the growth and survival of normal and cancerous breast epithelial cells by binding and activating the estrogen receptor (ER). Thats not unusual but it does not mean your ovaries are not functioning or that youre menopausal. Aromatase inhibitors help lower estrogen levels, but they dont stop the ovaries from making estrogen. Khosrow-Khavar F, et al. Patients with LABC who achieve an excellent response to induction chemotherapy have outcomes similar to those in patients with early-stage disease.15 Preoperative chemotherapy downsizes the local tumor, facilitating breast-conserving surgery. If youre receiving chemotherapy, you might stop having periods. All three aromatase inhibitors work the same way and reduce the production of estrogen in the body. Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P1 Study. A 2020 article in the Journal of Clinical Oncology shows that 79 to 84 percent of breast cancers test positive for estrogen receptors. Lobular carcinoma in situ does not require treatment. Several strategies are used to treat hormone-sensitive breast cancer: Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. It supports your sexual and reproductive health. Women age 70 or above with low-risk early breast cancer who are reluctant or unable to pursue adjuvant aromatase inhibition can safely pursue adjuvant radiation alone with limited differences in outcome and a modest increase in costs. Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. They may also prescribe aromatase inhibitor therapy if: Aromatase inhibitors are pills that you take every day. 18, 19 Aromatase inhibitors also appear to be associated with . A red spot on your breast is more likely to be a pimple, bug bite, or rash than a, Inflammatory breast cancer is a rare and aggressive form of breast cancer that occurs when malignant cells block the skin and lymph vessels of the, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. For most women, the benefit of the extra 5 years of treatment is small [ 109 ]. If the tumor cells contain estrogen receptors, the cancer is called estrogen receptor positive (ER positive), estrogen sensitive, or estrogen responsive. Slamon DJ, Neven P, Chia S, et al. Most ER-positive breast cancers are also PR positive. Axillary lymph node dissection should be performed in women who have breast cancer with clinically palpable lymph nodes. One early study compared outcomes for those who took the aromatase inhibitor letrozole after tamoxifen and people who didnt. Aromatase inhibitors as adjuvant treatment for breast cancer. Strategies for Increasing the Effectiveness of Aromatase Inhibitors in Locally Advanced Breast Cancer: An Evidence-Based Review on Current Options. Want to use this content on your website or other digital platform? After induction chemotherapy, patients are usually treated with mastectomy followed by chest wall radiation. This study aims to determine if P maintenance with an alternative ET improves the antitumor activity of second-line treatment in this . Aromatase inhibitor therapy has side effects that may affect your quality of life. If you take aromatase inhibitors, you may have the following side effects: The most significant benefit is being free of ER-positive breast cancer. Ingle JN, Tu D, Pater JL, et al. Breast Cancer Res Treat. The cost-efficacy of each strategy was considered using the quality-adjusted life year and incremental cost-effectiveness ratio (ICER). Lancet Oncology 2015; 16(1):6775. Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. A 2015 study found that combining aromatase inhibitors with ovarian suppression medications was effective in reducing the risk of cancer recurrence in premenopausal women with breast cancer. If you have an increased risk of developing ER-positive breast cancer, taking an aromatase inhibitor may reduce your risk. Those treated with an aromatase inhibitor usually also take a GnRH agonist. Current Drug Metabolism 2002; 3(1):1337. Vogel VG, Costantino JP, Wickerham DL, et al. It is unknown whether patients with intolerable toxicity from one AI are able to tolerate another. Cancers (Basel). An enzyme called aromatase takes other hormones and converts them into estrogen. However, theyre not for everyone with ER-positive breast cancer. Cristofanilli M, Turner NC, Bondarenko I, et al. Extensive lymph node involvement (i.e., more than three axillary, internal mammary, or clavicular nodes), residual pathologic tumors larger than 2 cm, multifocal residual disease, and lymphovascular invasion increase the rate of local recurrence following breast-conserving surgery after induction chemotherapy and, therefore, warrant mastectomy.19, Most patients presenting with LABC have clinically positive lymph nodes and require ALN dissection. In mice, procyanidin B dimers have been shown to reduce the growth of breast cancer tumors, explains Proctor, a board-certified oncology dietitian at Leonard Cancer Institute with Providence Mission Hospital in California. The study showed that taking letrozole reduced the risk of dying of breast cancer by 24% to 35%. Aromatase inhibitors are common medications to treat hormone receptor-positive breast cancer in postmenopausal women and have been shown to improve survival and prevent disease recurrence. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease. Approximately 11 and 20 percent of patients treated with adjuvant therapies develop locoregional recurrence within five and 10 years, respectively.56 Locoregional recurrence is an indicator of an aggressive tumor, and early recurrence carries a poor prognosis.57 Recurrence without clinical metastases has a five-year survival of approximately 40 percent.22 Mastectomy is indicated for in-breast tumor recurrence after breast-conserving surgery, followed by repeat axillary staging. Prognosis is poor in women with recurrent or metastatic (stage IV) breast cancer, and treatment options must balance benefits in length of life and reduced pain against harms from treatment. Approximately 20 to 30 percent of early-stage breast cancers overexpress ERBB2.44,45 These cancers generally have a worse prognosis. How is hormone therapy used to treat breast cancer? Ruhstaller T, Giobbie-Hurder A, Colleoni M, et al. Predictors of treatment discontinuation are not clearly defined. Results: 2021 Dec 8;28(6):5215-5226. doi: 10.3390/curroncol28060436. Aromatase inhibitors, with or without tamoxifen, should be offered to all postmenopausal women with hormone receptorpositive breast cancer. However, the ICER was unstable owing to a denominator that approached zero. Whos a good candidate for aromatase inhibitors? 1-877 GO KOMEN Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: long term results of the Italian Tamoxifen Anastrozole trial. In women with rapidly progressive disease, it may be better to treat with chemotherapy, which is more likely to induce a timely response. Adv Radiat Oncol. Label: Aromasin- exemestane tablet. Discover which breast changes you should report to a doctor, treatment, outlook, and more. Savard MF, Alzahrani MJ, Saunders D, Chang L, Arnaout A, Ng TL, Brackstone M, Vandermeer L, Hsu T, Awan AA, Cole K, Larocque G, Clemons M. Curr Oncol. EIN 75-1835298. Aromatase Inhibitors-Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects. ER-positive breast cancer often affects women and people assigned female at birth (AFAB) who are age 50 and older. Postmenopausal women diagnosed with hormone-receptor-positive disease are 35% to 61% more likely to have breast cancer come back if they don't take hormonal therapy as prescribed. Examples of ovarian suppression drugs are goserelin(Zoladex) and leuprolide(Lupron). Estrogen is an essential hormone. The estimated mortality rates at 90 days were 25.5% for the P2Y12 inhibitor group and 27.0% for the usual care group (adjusted hazard ratio, 0.96; 95% CI, 0.76-1.23; P = .77). During the study period from 5 to 20 years, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% for high-grade disease; the corresponding risks of any recurrence or a contralateral breast cancer were 17%, 22%, and 26%, respectively. This therapy involves removing the tumor without removing excess healthy breast tissue, with the outcome of a breast that is more aesthetically acceptable to the patient than the outcome from radical mastectomy. A 2016 study suggests that eating a lot of meats and sugars may contribute to high estrogen levels in postmenopausal women. 1001 Background: Cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i) in combination with ET has become a standard first-line treatment for pts with endocrine-sensitive, HR[+]/HER2[-] ABC. 8600 Rockville Pike Our website services, content, and products are for informational purposes only. Read on as we take a closer look at aromatase inhibitors and who can use them. Hormones are substances that function as chemical messengers in the body. Lancet Oncology 2018; 19(7):904915. Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen. The aromatase inhibitors anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara) all have a similar benefit [1]. Journal of Clinical Oncology 2003; 21(11):21012109. That means the cancer. Several studies have suggested a "sweet spot" of 7 to 8 years' duration. A 2020 article in the Journal of Clinical Oncology shows that 79 to 84 percent of breast cancers test positive for estrogen receptors. Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intention-to-treat analysis of the National Surgical Adjuvant Breast and Bowel Project B-33 trial. Patient information: See related handout on breast cancer treatment, written by the authors of this article. One goal of aromatase inhibitor treatment is to lower estrogen levels. What Are the Treatment Options for Triple-Negative Breast Cancer (TNBC)? See permissionsforcopyrightquestions and/or permission requests. J Clin Oncol. What are aromatase inhibitors? New England Journal of Medicine 2018; 379(2):122137. Following initial treatment, breast cancer can recur locally, regionally (nodes), or at distant metastatic sites. Unable to load your collection due to an error, Unable to load your delegates due to an error. JAMA 2006; 295(23):27272741. Aromatase inhibitors were superior in preventing contralateral cancers, with a small impact on the risk of distant metastatic disease. Cuzick J, et al. This content is owned by the AAFP. For example, some women may take an aromatase inhibitor, instead of tamoxifen, every day for 5 years. Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. MeSH Studies show 95% of people who receive aromatase inhibitor therapy after breast cancer surgery dont have breast cancer signs five years after completing treatment. If you have this side effect, ask your healthcare provider for help. Rimawi M, Ferrero JM, de la Haba-Rodriguez J, et al. Pathologic lymph node evaluation is not usually performed because nodal metastasis is rare. Learn about the treatment options for triple-negative breast cancer (TNBC). There are some other uses for this medication, too. The model's predicted outcomes matched those demonstrated by modern trials. Management of male breast cancer: ASCO guideline. Clin Ther. Hormone receptornegative disease derives more benefit from chemotherapy than hormone receptorpositive disease.47 Factors such as age and comorbidities also influence the decision to use chemotherapy. Both of these drugs and the aromatase inhibitor exemestane are also approved to treat postmenopausal women with advanced breast cancer whose disease has worsened after treatment with tamoxifen (14). Annual Report to the Nation on the Status of Cancer, 19752011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. This article reviews typical treatments based on stage, histology, and biomarkers. MONARCH 1, a phase II Study of abemaciclib, a CDK4 and CDK6 inhibitor, as a single agent, in patients with refractory HR+/HER2- metastatic breast cancer. Estrogen and progesterone production in premenopausal women. Your doctor may suggest adjuvant therapy as part of your breast cancer treatment. Tamoxifen is approved for this use regardless of menopausal status. A humanized anti-ERBB2 monoclonal antibody, trastuzumab (Herceptin), improves disease-specific and overall survival when added to anthracyclines and paclitaxel (Taxol) chemotherapy in women with node-positive and high-risk, node-negative breast cancers overexpressing ERBB2.13,14 The combination of trastuzumab and anthracyclines must be used with caution, however, because cardiac toxicity will develop in 2 to 3 percent of patients over two years of treatment. official website and that any information you provide is encrypted Node-positive disease benefits most from systemic therapy. In the Japanese AERAS trial, which evaluated the continuation of the same aromatase inhibitor, the 5-year disease-free survival rate was 91.9% with continued therapy vs 84.4% with 5 years of an aromatase inhibitor; survival was no different, at about 99% in both arms. That means the cancer cells use estrogen to fuel growth. helpline@komen.org, Donor Services Support: HR-positive breast cancer demonstrates the best survival rates (90.3%-92.5% 4-year survival rate) compared with epidermal growth factor . During the study period from 5 to 20 years, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% . Metastatic breast cancer is cancer thats spread from the breasts. This site needs JavaScript to work properly. 2022 Mar 1;20(1):9. doi: 10.1186/s12962-022-00342-7. 2007 Jul;11(26):iii-iv, ix-xi, 1-134. doi: 10.3310/hta11260. 37(2):105-114, 2019. and transmitted securely. 4,5,11,12,13 Ward MC, Vicini F, Al-Hilli Z, Chadha M, Pierce L, Recht A, Hayman J, Thaker N, Khan AJ, Keisch M, Shah C. Breast Cancer Res Treat. Inflammatory breast cancer is relatively rare and is characterized by diffuse erythema and edema (peau dorange), no palpable mass, early age at diagnosis, poor nuclear grade, negative hormonereceptor status, and poor survival outcome. Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): An international, randomised, double-blind, phase 3 trial. Three aromatase inhibitors (AIs) are now FDA approved and have been shown to be more effective than the antiestrogen tamoxifen and are well tolerated. The antiestrogen fulvestrant is approved for postmenopausal women with metastatic ER-positive breast cancer that has spread after treatment with other antiestrogens (10). Approximately 67%80% of breast cancers in women are ER positive (1, 2). Eight survival metrics were assessed and validated against clinical trial data. Breast cancer prevention with grape seed phytochemicals. Studies show people who take aromatase inhibitors after breast cancer surgery remain free of breast cancer for five or more years after treatment. Lancet 2014; 383(9922):10411048. The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LHand follicle-stimulating hormone (FSH). However, some patients may prefer radiation without hormone therapy, for which there is minimal modern data. Label: Femara- letrozole tablet, film coated. FOIA (https://pubmed.ncbi.nlm.nih.gov/32781535/), You have ER-positive breast cancer thats spread to nearby. Experiences and Perceptions of Older Adults with Lower-Risk Hormone Receptor-Positive Breast Cancer about Adjuvant Radiotherapy and Endocrine Therapy: A Patient Survey. Aromatase inhibitors should be considered in all post-menopausal women with hormone receptorpositive breast cancer. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Radiation therapy is recommended only in the setting of inoperable or incompletely resected recurrent disease. However, a person may tolerate one drug better than another. Youre a man or assigned male at birth (AMAB) with ER-positive breast cancer. Aromatase inhibitors versus tamoxifen in early breast cancer: Patient-level meta-analysis of the randomised trials. Chemotherapy, endocrine therapy, and tissue-targeted therapies enhance definitive local therapy (surgery, radiation therapy, or both), substantially decreasing cancer recurrence and disease-specific death. Some women with advanced breast cancer are treated with a combination of hormone therapy and one of several targeted therapies: Neoadjuvant treatment of breast cancer: The use of hormone therapy to treat breast cancer to reduce tumor size before surgery (neoadjuvant therapy) has been studied in clinical trials (24). J Clin Oncol. Copyright 2019 Elsevier Inc. All rights reserved.
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