[Adjuvant endocrine therapy in breast cancer]

Tamoxifen is the standard treatment in premenopausal hormone-receptor positive breast cancer patients with additional benefit in some of these women by adding ovarian ablation or suppression. Actual trials are investigating the use of more complete estradiol suppression with an LHRH agonist in combination with an aromatase inhibitor (TEXT, SOFT and ABCSG 12 trial) in premenopausal patients. Outside clinical trials this treatment may be considered in special cases when tamoxifen is contraindicated. In the majority of postmenopausal women the optimal adjuvant hormonal therapy includes the use of an aromatase inhibitor. However the best use of these agents, either as initial therapy or after treatment with tamoxifen has still to be answered. Again the optimal duration of endocrine therapy remains still open. Extended adjuvant therapy with an AI after completion of five years tamoxifen is especially in node positive patients a reasonable option. However if extension of endocrine therapy with an AI after five years of an AI-containing regimen is also beneficial is currently investigated in several clinical trials. In selected postmenopausal patients with hormone-receptor positive disease the use of five years of tamoxifen can still be a viable option.