Treatment
Updated Recommendations on Extended Therapy
➤ Many women with node-negative breast cancer are potential candidates
for and may be offered extended AI therapy for up to a total of 10 years of
adjuvant endocrine treatment based on considerations of recurrence risk
using established prognostic factors. However, as the recurrence risk
is lower, the benefits are likely narrower for such patients. Women with
low-risk node-negative tumors should not routinely be offered extended
therapy.
➤ Women with node-positive breast cancer should be offered extended AI
therapy for up to a total of 10 years of adjuvant endocrine treatment.
➤ Women receiving extended adjuvant endocrine therapy should receive no
more than 10 years of total treatment.
➤ As prevention of secondary or contralateral breast cancers is a major
benefit of extended AI therapy, the risk of second breast cancers (or not)
based on prior therapy should inform the decision to pursue extended
treatment.
➤ Extended therapy carries ongoing risks and side effects, which should be
weighed against the potential absolute benefits of longer treatment in a
shared decision-making process between the clinical team and the patient.
Qualifying Statement: To date, none of the studies has shown improvement in overall survival
with longer duration AI therapy. As such, the recommendations on extended adjuvant AI
therapy are based on benefits that include prevention of distant recurrence and prevention of
second breast cancers.
Recommendations on Ovarian Suppression
➤ The Panel recommends that higher risk patients should receive ovarian
suppression in addition to adjuvant endocrine therapy while lower risk
patients should not.
Qualifying Statement:
The Panel notes that two prospective studies did not show overall clinical benefit for the
addition of ovarian suppression to tamoxifen in premenopausal, ER-positive breast cancer.
However, in a large subset of women with higher risk cancers, nearly all of whom received
chemotherapy but remained premenopausal, ovarian suppression added to tamoxifen reduced
the risk of breast cancer recurrence. Because of the design of the clinical trials, there are few
definitive criteria by which to define risk.
