Dr. Gradishar on Endocrine Therapy in Early Stage Disease

William J. Gradishar, MD, Professor in Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, discusses the treatment of early stage breast cancer with endocrine therapy and considerations following resistance.

A patient with early stage disease who is hormone-sensitive will receive the recommendation to get anti-hormonal therapy, regardless of whether or not they are treated with chemotherapy. The treatment of choice is tamoxifen and an aromatase inhibitor for premenopausal and postmenopausal patients, respectively.

Following treatment, if a patient goes on to develop recurrent metastatic disease, the decision regarding next steps depends on whether or not the patient is premenopausal or postmenopausal and the extent of their disease. Gradishar says that treatment continues as long as the disease remains stable. If it came that the disease was progressing, a physician would go through the same decision tree: considering chemotherapy, alternative endocrine therapies, what the tumor had been exposed to, enrollment on a clinical trial, and an aromatase inhibitor plus mTOR inhibitor. For patients who develop disease progression and remain endocrine-sensitive, a physician would treat with everolimus plus exemestane and continue until disease progression. At that point, a patient would have received most endocrine therapies and chemotherapy would have to be considered.