Endocrine management of advanced breast cancer

Recent research has produced several new options for endocrine treatment of advanced breast cancer. Since one of the most intriguing characteristics of endocrine therapy is that new remissions are possible when subsequent endocrine modalities are used, it is important to evaluate their optimal sequence. Tamoxifen has become the most commonly used endocrine therapy for advanced breast cancer due to its few side effects and an overall response rate of 35%. Crossover data from randomised trials, comparing tamoxifen with either ablative, additive or inhibitive treatment, indicate that the highest overall response rate is obtained when tamoxifen is used as first-line endocrine therapy. Furthermore, it seems that oophorectomy in premenopausal, and aminoglutethimide or progestins in postmenopausal patients, are equally effective as second-line endocrine therapy. Despite an obvious clinical rationale for combined endocrine therapy, most trials have failed to show any benefit. Although data from trials combining tamoxifen with prednisolone or androgens seem promising, the use of combined endocrine therapy still has to be considered experimental.