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Management of patients with hormone receptor–positive breast cancer with visceral disease: challenges and treatment options

Authors Harb WA

Received 12 August 2014

Accepted for publication 15 September 2014

Published 19 January 2015 Volume 2015:7 Pages 37—46

DOI https://doi.org/10.2147/CMAR.S72592

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Kenan Onel

Video abstract presented by Wael A Harb

Views: 286

Wael A Harb

Horizon Oncology Center, Lafayette, IN, USA

Abstract: Endocrine therapy is an important treatment option for women with hormone receptor–positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor®), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin®) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed.

Keywords: endocrine resistance, endocrine therapy, targeted therapy

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