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Current Oncology
Volume 20
Issue 1
10.3747/co.20.1316
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Article

Endocrine Therapy for Postmenopausal Women with Hormone Receptor–Positive her2–Negative Advanced Breast Cancer after Progression or Recurrence on Nonsteroidal Aromatase Inhibitor Therapy: A Canadian Consensus Statement

by
K.I. Pritchard
1,*,
K.A. Gelmon
2,
D. Rayson
3,
L. Provencher
4,
M. Webster
5,
D. McLeod
6 and
S. Verma
7
1
Sunnybrook Odette Cancer Centre and the University of Toronto, Toronto, ON, Canada
2
BC Cancer Agency, Vancouver, BC, Canada
3
QEII Health Sciences Centre, Halifax, NS, Canada
4
Centre des Maladies du Sein Deschênes–Fabia, CHU de Québec, Hôpital St-Sacrement, Québec City, QC, Canada
5
Tom Baker Cancer Center, Calgary, AB, Canada
6
Kaleidoscope Strategic, Toronto, ON, Canada
7
Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2013, 20(1), 48-61; https://doi.org/10.3747/co.20.1316
Submission received: 2 November 2012 / Revised: 3 December 2012 / Accepted: 4 January 2013 / Published: 1 February 2013

Abstract

Approximately 22,700 Canadian women were expected to be diagnosed with breast cancer in 2012. Despite improvements in screening and adjuvant treatment options, a substantial number of postmenopausal women with hormone receptor positive (hr+) breast cancer will continue to develop metastatic disease during or after adjuvant endocrine therapy. Guidance on the selection of endocrine therapy for patients with hr+ disease that is negative for the human epidermal growth factor receptor 2 (her2–) and that has relapsed or progressed on earlier nonsteroidal aromatase inhibitor (nsai) therapy is of increasing clinical importance. Exemestane, fulvestrant, and tamoxifen are approved therapeutic options in this context. Four phase iii trials involving 2876 patients—efect, sofea, confirm, and bolero-2—have assessed the efficacy of various treatment options in this clinical setting. Data from those trials suggest that standard-dose fulvestrant (250 mg monthly) and exemestane are of comparable efficacy, that doubling the dose of fulvestrant from 250 mg to 500 mg monthly results in a 15% reduction in the risk of progression, and that adding everolimus to exemestane (compared with exemestane alone) results in a 57% reduction in the risk of progression, albeit with increased toxicity. Multiple treatment options are now available to women with hr+ her2– advanced breast cancer recurring or progressing on earlier nsai therapy, although current clinical trial data suggest more robust clinical efficacy with everolimus plus exemestane. Consideration should be given to the patient’s age, functional status, and comorbidities during selection of an endocrine therapy, and use of a proactive everolimus safety management strategy is encouraged.
Keywords: advanced breast cancer; endocrine therapy; mtor-inhibitor; nonsteroidal aromatase inhibitor; everolimus; fulvestrant; exemestane; endocrine resistance advanced breast cancer; endocrine therapy; mtor-inhibitor; nonsteroidal aromatase inhibitor; everolimus; fulvestrant; exemestane; endocrine resistance

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MDPI and ACS Style

Pritchard, K.I.; Gelmon, K.A.; Rayson, D.; Provencher, L.; Webster, M.; McLeod, D.; Verma, S. Endocrine Therapy for Postmenopausal Women with Hormone Receptor–Positive her2–Negative Advanced Breast Cancer after Progression or Recurrence on Nonsteroidal Aromatase Inhibitor Therapy: A Canadian Consensus Statement. Curr. Oncol. 2013, 20, 48-61. https://doi.org/10.3747/co.20.1316

AMA Style

Pritchard KI, Gelmon KA, Rayson D, Provencher L, Webster M, McLeod D, Verma S. Endocrine Therapy for Postmenopausal Women with Hormone Receptor–Positive her2–Negative Advanced Breast Cancer after Progression or Recurrence on Nonsteroidal Aromatase Inhibitor Therapy: A Canadian Consensus Statement. Current Oncology. 2013; 20(1):48-61. https://doi.org/10.3747/co.20.1316

Chicago/Turabian Style

Pritchard, K.I., K.A. Gelmon, D. Rayson, L. Provencher, M. Webster, D. McLeod, and S. Verma. 2013. "Endocrine Therapy for Postmenopausal Women with Hormone Receptor–Positive her2–Negative Advanced Breast Cancer after Progression or Recurrence on Nonsteroidal Aromatase Inhibitor Therapy: A Canadian Consensus Statement" Current Oncology 20, no. 1: 48-61. https://doi.org/10.3747/co.20.1316

APA Style

Pritchard, K. I., Gelmon, K. A., Rayson, D., Provencher, L., Webster, M., McLeod, D., & Verma, S. (2013). Endocrine Therapy for Postmenopausal Women with Hormone Receptor–Positive her2–Negative Advanced Breast Cancer after Progression or Recurrence on Nonsteroidal Aromatase Inhibitor Therapy: A Canadian Consensus Statement. Current Oncology, 20(1), 48-61. https://doi.org/10.3747/co.20.1316

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