Adjuvant endocrine treatment of breast cancer beyond St. Gallen 2003

Abstract

During the recently held 8th International Conference on Primary Therapy of Early Breast Cancer, (March 12-15, 2003 St. Gallen/Switzerland) established recommendations for adjuvant endocrine treatment were confirmed, while new options were introduced. Ovarian ablation, limited for 2 years (e. g. Goserelin, combined with 5 years of Tamoxifen), was suggested as an effective treatment option in premenopausal patients with a hormonsensitive breast cancer. The efficacy of this endocrine regimen is equivalent to CMF-chemotherapy in these patients. In "very" young patients with hormonsensitive tumors, chemotherapy alone is not sufficient. These patients will particularly benefit from endocrine treatment. The reversibility of endocrine treatment is its main advantage, avoiding long lasting symptoms of hormone deficiency. In postmenopausal hormonsensitive patients the aromatase inhibitor Anastrozol (Arimidex trade mark ) has been approved as an alternative for patients with contraindications against Tamoxifen (e. g. increased risk of thromboembolism, varicosis, smokers, endometrium changes). The initiation of endocrine should be postponed until the completion of chemotherapy, because combined application reduces the efficacy of adjuvant treatment. "Older" patients will get only limited advantage of chemoendocrine treatment compared to endocrine treatment alone. Preliminary treatment recommendations comprise a wide range of possible treatment options.