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Woo and Lim: Endocrine Therapy for Breast Cancer
Review Article
Special Issues for Breast Cancer

The Ewha Medical Journal 2014; 37(2): 83-91.

Published online: 30 September 2014

DOI: https://doi.org/10.12771/emj.2014.37.2.83

Endocrine Therapy for Breast Cancer

Joohyun Woo, Woosung Lim

Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Woosung Lim. Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Anyancheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-10-2570-8980, Fax: 82-2-2644-7984, limw@ewha.ac.kr

Received 1 August 2014       Accepted 29 August 2014

Copyright © 2014. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Breast cancer is the second most common cancer in Korean women and its mortality rate has increased steadily. Although breast cancer is heterogeneous tumor, hormone receptor-positive tumors comprise about 75 percent of all breast cancers. Therefore endocrine therapy that works by targeting estrogen receptor is a pivotal treatment for breast cancers. There are selective estrogen receptor modulators, such as tamoxifen and raloxifene, aromatase inhibitors, such as anastrozole, letrozole and exemestane, fulvestrant and luteinizing hormone-releasing hormone agonists used in endocrine therapy. Endocrine therapy is effective in treating early breast cancer as an adjuvant therapy and metastatic breast cancer as a palliative therapy. Also in women who are at high risk for breast cancer, tamoxifen or raloxifene can prevent breast cancer. Studies for neoadjuvant endocrine therapy are emerging. Considering side effects of each drug and overcoming drug resistance are needed to maximize effectiveness of treatment and advance endocrine therapy.

Keywords: Breast neoplasms, Drug therapy, Antineoplastic agents, hormonal

Figures and Tables

Fig. 1
(A) Pre- and (B) posttreatment breast magnetic resonance imaging (MRI) in a patient who received neoadjuvant endocrine therapy. A 72-year-old woman was diagnosed with breast cancer on April, 2013. A left subareolar mass was confirmed as invasive ductal carcinoma by core needle biopsy and immunohistochemistry revealed that the tumor was estrogen receptor- and progesterone receptor-positive, and C-erbB2-negative breast cancer. She was treated with letrozole for 6 months. MRI shows the clinical response of neoadjuvant endocrine therapy. The size of primary tumor partially decreased from 4.2 cm to 3.0 cm on MRI after neoadjuvant endocrine therapy for 6 months (arrows). Also metastatic lymph node in left axilla disappeared (not shown).
emj-37-83-g001
Table 1
A summary of research studies on adjuvant tamoxifen
emj-37-83-i001

NSABP, National Surgical Adjuvant Breast and Bowel Project; ER, estrogen receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; ATLAS, Adjuvant Tamoxifen Longer Against Shorter; aTTom, adjuvant Tamoxifen Treatment offers more.

Table 2
A summary of research studies on adjuvant aromatase inhibitor
emj-37-83-i002

IBCSG, International Breast Cancer Study Group; BIG, Breast International Group; ER, estrogen receptor; ATAC, arimidex, tamoxifen, alone or in combination; PR, progesterone receptor; EBCTCG, Early Breast Cancer Trialists' Collaborative Group; AI, aromatase inhibitor.

Table 3
A summary of research studies on neoadjuvant endocrine therapy
emj-37-83-i003

ER, estrogen receptor; PR, progesterone receptor; IMPACT, immediate preoperative anastrozole, tamoxifen, or combined with tamoxifen; PROACT, pre-operative "arimidex" compared to tamoxifen; ACOSOG, American college of surgeons oncology group; PEPI, Preoperative endocrine prognostic index.

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