Based on the available evidence on this regard, the best endocrine agent to be combined with ovarian function suppression appears to be an aromatase inhibitor for premenopausal patients with estrogen receptor-positive/HER2-negative early breast cancer at the highest risk of disease recurrence. On the other hand, tamoxifen alone or combined with ovarian function suppression remains an available option for women with more favorable prognostic features as well as for those who do not tolerate the use of aromatase inhibitors. Final results of the ongoing phase III HOBOE study (ClinicalTrials.gov Identifier: NCT00412022; expected for end of 2018) are awaited to give further insight on the role of ovarian function suppression and aromatase inhibitors [29,30].
In the last few years, we have assisted to a significant change in the endocrine treatment landscape of premenopausal women with estrogen receptor-positive early breast cancer and the choice of the optimal adjuvant endocrine therapy has now become rather complex in this setting . With the only exception of patients with low-risk clinical-pathological features characterized by excellent survival outcomes with tamoxifen alone, the use of ovarian function suppression is to be considered standard of care for most of these premenopausal women. Regarding the choice of its best partner as endocrine agent, the available data suggest that the higher the risk of disease recurrence the larger benefit can be observed with a more profound estrogen deprivation that can be obtained with ovarian function suppression and an aromatase inhibitor as compared with ovarian function suppression and tamoxifen. All the recently updated guidelines support these considerations (Table 1) [32▪▪–35▪▪].
Papers of particular interest, published within the annual period of review, have been highlighted as:
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International recommendations on the management of breast cancer in young women in 2014.
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25. Regan MM, Pagani O, Francis PA, et al. Predictive value and clinical utility of centrally assessed ER, PgR, and Ki-67 to select adjuvant endocrine therapy
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American Society of Clinical Oncology guidelines on the use of adjuvant ovarian function suppression in patients with estrogen receptor-positive early breast cancer.
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Italian Association of Medical Oncology guidelines on the use of adjuvant endocrine therapy in premenopausal patients with estrogen receptor-positive early breast cancer.
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50. Ruddy KJ, DeSantis SD, Barry W, et al. Extended therapy with letrozole and ovarian suppression in premenopausal patients
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