scholarly journals Assessment and management of bone health in women with oestrogen receptor‐positive breast cancer receiving endocrine therapy: position statement summary

2019 ◽  
Vol 211 (5) ◽  
pp. 224-229 ◽  
Author(s):  
Mathis Grossmann ◽  
Sabashini K Ramchand ◽  
Frances Milat ◽  
Amanda Vincent ◽  
Elgene Lim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Bone Health ◽  
Oestrogen Receptor ◽  
Position Statement ◽  
Positive Breast Cancer

scholarly journals Identifying Biomarkers to Select Patients with Early Breast Cancer Suitable for Extended Adjuvant Endocrine Therapy

Breast Care ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. 146-151 ◽  
Author(s):  
Ivana Sestak
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Oestrogen Receptor ◽  
Clinical Information ◽  
Late Recurrence ◽  
Correct Identification ◽  
Breast Cancer Therapy ◽  
Increased Risk ◽  
Extended Endocrine Therapy ◽  
Positive Breast Cancer

Postmenopausal women with early oestrogen receptor-positive breast cancer who have received 5 years of endocrine therapy are at increased risk of developing a recurrence. An important clinical question is how to identify women who are at highest (or lowest) risk of a recurrence. The use of prognostic biomarkers allows individualised breast cancer therapy but correct identification of patients who will benefit most from extended endocrine therapy is essential. Several multigene assays have been developed to determine the likelihood of overall recurrence but so far none exist specifically for the prediction of late recurrence. Recent results from large clinical trials have shown that biomarker assays that include clinical information in their tests might be useful to predict and risk stratify patients for late recurrence. However, further research is needed to specifically offer multigene assays for the identification of late recurrence and thus justify routine use of these tests in the clinical setting.

Evaluating bone health in women with oestrogen receptor positive breast cancer (ERBC) starting aromatase inhibitors

2009 ◽  
Vol 35 (5) ◽  
pp. 475-480 ◽  
Author(s):  
G.P. Clunie ◽  
A. Clark ◽  
C.J. Mortimer ◽  
S. Stephenson ◽  
J. Aitken ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Aromatase Inhibitors ◽  
Bone Health ◽  
Oestrogen Receptor ◽  
Positive Breast Cancer

scholarly journals The effects of adjuvant endocrine therapy on bone health in women with breast cancer

2019 ◽  
Vol 241 (3) ◽  
pp. R111-R124 ◽  
Author(s):  
Sabashini K Ramchand ◽  
Yee-Ming Cheung ◽  
Belinda Yeo ◽  
Mathis Grossmann
Keyword(s):  
Breast Cancer ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Endocrine Therapy ◽  
Aromatase Inhibitors ◽  
Bone Health ◽  
Oestrogen Receptor ◽  
Breast Tissue ◽  
Premenopausal Women ◽  
Er Positive

In women with oestrogen receptor (ER)-positive early breast cancer, oestradiol is important for breast cancer development and progression. Endocrine therapy prevents the deleterious effects of oestradiol in breast tissue by systemically depleting oestradiol concentration (aromatase inhibitors) or preventing its local action in breast tissue (selective oestrogen receptor modulators i.e. tamoxifen), thereby improving oncological outcomes. Use of aromatase inhibitors in postmenopausal women and ovarian function suppression with either tamoxifen or aromatase inhibition in premenopausal women, consequent to systemic oestradiol depletion, exerts detrimental effects on skeletal health. The oestradiol-deficient state causes increased bone remodelling and a negative bone balance. This results in bone loss, microstructural deterioration and bone fragility predisposing to fractures. Similar effects are also seen with tamoxifen in premenopausal women. In contrast, use of tamoxifen in postmenopausal women appears to exert protective effects on bone but studies on fracture risk are inconclusive. The longevity of women with ER-positive breast cancer treated with adjuvant endocrine therapy emphasises the need to mitigate the adverse skeletal effects of these therapies in order to maximise benefit. In general, fractures are associated with increased morbidity, mortality and are a high socioeconomic burden. Whilst the efficacy of antiresorptive therapy in preventing bone mineral density loss in postmenopausal women has been established, further clinical trial evidence is required to provide guidance regarding fracture risk reduction, when to initiate and stop treatment, choice of agent and optimal management of bone health in premenopausal women receiving endocrine therapy. In addition, potential oncological benefits of antiresorptive therapies will also need to be considered.

scholarly journals Clinical validity of clinical treatment score 5 (CTS5) for estimating risk of late recurrence in unselected, non-trial patients with early oestrogen receptor-positive breast cancer

2020 ◽  
Author(s):  
Juliet Richman ◽  
Alistair Ring ◽  
Mitch Dowsett ◽  
Ivana Sestak
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Postmenopausal Women ◽  
Endocrine Therapy ◽  
Oestrogen Receptor ◽  
Premenopausal Women ◽  
Clinical Validity ◽  
Er Positive ◽  
Extended Endocrine Therapy ◽  
Positive Breast Cancer

Abstract Purpose Clinical Treatment Score at 5 years (CTS5) is a prognostic tool to estimate distant recurrence (DR) risk after 5 years of endocrine therapy for postmenopausal women with oestrogen receptor-positive (ER-positive) breast cancer. Methods The validity of CTS5 was tested in a retrospective cohort of patients diagnosed with early ER-positive breast cancer. The primary endpoint was DR in years 5–10. The primary analysis cohort consisted of postmenopausal women, with premenopausal women as a secondary analysis cohort. Cox regression models were used to determine the prognostic value of CTS5 and Kaplan–Meier curves were used with associated 10-year DR risks (%). Results 2428 women were included with a median follow-up of 13.4 years. The CTS5 was significantly prognostic in both postmenopausal (N = 1662, HR = 2.18 95% CI (1.78–2.67)) and premenopausal women (N = 766, HR = 1.84 95% CI (1.32–2.56)). The 10-year DR risks were 2.9% (1.9–4.5), 7.2% (5.3–9.9), and 12.9% (10.0–16.7) for low, intermediate and high risk in postmenopausal women and 3.8% (2.2–6.7), 6.9% (4.4–10.8), and 11.1% (7.4–16.5) in premenopausal women, respectively. The number of observed DRs was significantly greater than expected in those predicted to be at high risk by CTS5 but this discordance was lost when those receiving more than 60 months of endocrine therapy were excluded. Conclusions The CTS5 demonstrated clinical validity for predicting late DR within a large cohort of unselected postmenopausal patients but less so in premenopausal patients. Calibration of the CTS5 was good in patients who did not receive extended endocrine therapy. The CTS5 low-risk cohort has risk of DR so low as to not warrant extended endocrine therapy.

scholarly journals CDC20 expression in oestrogen receptor positive breast cancer predicts poor prognosis and lack of response to endocrine therapy

2019 ◽  
Vol 178 (3) ◽  
pp. 535-544 ◽  
Author(s):  
Lutfi H. Alfarsi ◽  
Rokaya El Ansari ◽  
Madeleine L. Craze ◽  
Michael S. Toss ◽  
Brendah Masisi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Poor Prognosis ◽  
Oestrogen Receptor ◽  
Positive Breast Cancer
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