Adjuvant Endocrine Therapy in Premenopausal Patients

Endocrine adjuvant therapy is the best-described molecular targeted treatment and should therefore be used for all patients with endocrine-responsive breast cancer. Ta-moxifen for 5 years is standard of care and has proven efficacy in premenopausal patients. The combination of tamoxifen with ovarian function suppression and/or chemotherapy has been extensively tested, and some controversial approaches are used in clinical practice. Cessation or suppression of ovarian function appears to be beneficial for premenopausal patients. Particularly for premenopausal women with highly endocrine-responsive disease and/or low risk for relapse, the additional benefit of cytotoxic chemotherapy may be minor or nonexistent. While the use aromatase inhibitors is investigated in clinical trials, their application outside an academic trial setting cannot be recommended based on first available results. In contrast, the use of adjuvant bispho-sphonates may offer another strategy of further improving clinical outcomes in this important patient subgroup.