Endocrine Therapy for Breast Cancer

Published:November 29, 2020DOI:https://doi.org/10.1016/j.nurpra.2020.10.015

      Highlights

      • Endocrine therapy is commonly used to treat breast cancer.
      • The duration of endocrine therapy is usually at least 5 years.
      • Side effects relate to estrogen inhibition.
      • Knowledge about endocrine therapy is important for primary care providers.

      Abstract

      Endocrine therapy is the primary treatment for the most common types of breast cancer. Endocrine agents work by inhibiting the tumor-stimulating effects of estrogen in hormone-sensitive tumors. A new class of targeted drugs synergize with endocrine agents to improve survival for patients with metastatic disease. Endocrine therapy is continued for years, and long-term survival is common, although toxicities often occur due to the alteration of the physiologic effects of estrogen. It is important, therefore, that primary care providers remain knowledgeable about patient needs during and after treatment.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sparano J.A.
        • Gray R.J.
        • Makower D.F.
        • et al.
        Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer.
        New Engl J Med. 2018; 379: 111-121https://doi.org/10.1056/NEJMoa1804710
        • American Cancer Society
        Breast Cancer Facts & Figures.
      1. Cancer of the Breast (Female). Cancer Stat Facts. n.d.
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA: Cancer J Clin. 2020; 70: 7-30https://doi.org/10.3322/caac.21590
        • Giordano S.H.
        Breast cancer in men.
        New Engl J Med. 2018; 378: 2311-2320https://doi.org/10.1056/NEJMra1707939
        • Waks A.G.
        • Winer E.P.
        Breast cancer treatment: a review.
        JAMA. 2019; 321: 288-300https://doi.org/10.1001/jama.2018.19323
        • American Cancer Society
        Cancer facts & figures for African Americans. n.d.
        • American Cancer Society
        Cancer Facts & Figures 2020.
      2. NCCN clinical practice guideline in oncology: breast cancer. Version 5.2020.
        (July 15, 2020)
        • Awan A.
        • Esfahani K.
        Endocrine therapy for breast cancer in the primary care setting.
        Curr Oncol. 2018; 25: 285-291https://doi.org/10.3747/co.25.4139
        • Early Breast Cancer Trialists’ Collaborative Group
        Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials.
        Lancet. 2015; 386: 1341-1352https://doi.org/10.1016/S0140-6736(15)61074-1
        • Early Breast Cancer Trialists’ Collaborative Group
        Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials.
        Lancet. 2011; 378: 771-784https://doi.org/10.1016/S0140-6736(11)60993-8
        • Colleoni M.
        • Sun Z.
        • Price K.N.
        • et al.
        Annual hazard rates of recurrence for breast cancer during 24 years of follow-up: results from the International Breast Cancer Study Group Trials I to V.
        J. Clin Oncol. 2016; 34: 927-935https://doi.org/10.1200/JCO.2015.62.3504
        • Caswell-Jin J.L.
        • Plevritis S.K.
        • Tian L.
        • et al.
        Change in survival in metastatic breast cancer with treatment advances: meta-analysis and systematic review.
        JNCI Cancer Spectrum. 2018; 2: pky062https://doi.org/10.1093/jncics/pky062
        • Shah M.
        • Nunes M.R.
        • Stearns V.
        CDK4/6 inhibitors: game changers in the management of hormone receptor–positive advanced breast cancer?.
        Oncology (Williston Park). 2018; 32: 216-222
        • Im S.-A.
        • Lu Y.-S.
        • Bardia A.
        • et al.
        Overall survival with ribociclib plus endocrine therapy in breast cancer.
        New Engl J Med. 2019; 381: 307-316https://doi.org/10.1056/NEJMoa1903765
        • Sledge G.W.
        • Toi M.
        • Neven P.
        • et al.
        The effect of abemaciclib plus fulvestrant on overall survival in hormone receptor–positive, ERBB2-negative breast cancer that progressed on endocrine therapy—MONARCH 2: a randomized clinical trial.
        JAMA Oncol. 2020; 6: 116-124https://doi.org/10.1001/jamaoncol.2019.4782
      3. Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. McGraw-Hill; 2018. https://accessmedicine-mhmedical-com.proxy.lib.duke.edu/content.aspx?bookid=2189§ionid=165936845. Accessed July 23, 2020.

        • Francis P.A.
        • Pagani O.
        • Fleming G.F.
        • et al.
        Tailoring adjuvant endocrine therapy for premenopausal breast cancer.
        New Engl J Med. 2018; 379: 122-137https://doi.org/10.1056/NEJMoa1803164
        • Visvanathan K.
        • Fabian C.J.
        • Bantug E.
        • et al.
        Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline update.
        J Clin. Oncol. 2019; 37: 3152-3165https://doi.org/10.1200/JCO.19.01472
        • Nelson H.D.
        • Fu R.
        • Zakher B.
        • Pappas M.
        • McDonagh M.
        Medication Use for the Risk Reduction of Primary Breast Cancer in Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
        JAMA. 2019; 322: 868-886https://doi.org/10.1001/jama.2019.5780
        • Pernas S.
        • Tolaney S.M.
        • Winer E.P.
        • Goel S.
        CDK4/6 inhibition in breast cancer: current practice and future directions.
        Ther Adv Med Oncol. 2018; 10: 1-15https://doi.org/10.1177/1758835918786451
        • Miaskowski C.
        • Shockney L.
        • Chlebowski R.T.
        Adherence to oral endocrine therapy for breast cancer: a nursing perspective.
        Clin J Oncol Nurs. 2008; 12: 213-221https://doi.org/10.1188/08.CJON.213-221
        • Pistilli B.
        • Paci A.
        • Ferreira A.R.
        • et al.
        Serum detection of nonadherence to adjuvant tamoxifen and breast cancer recurrence risk.
        J Clin Oncol. 2020; (JCO.19.01758)https://doi.org/10.1200/JCO.19.01758
        • Runowicz C.D.
        • Leach C.R.
        • Henry N.L.
        • et al.
        American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.
        J Clin Oncol. 2016; 34: 611-635https://doi.org/10.1200/JCO.2015.64.3809
        • Aiello Bowles E.J.
        • Boudreau D.M.
        • Chubak J.
        • et al.
        Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer.
        J Oncol Pract. 2012; 8: e149-e157https://doi.org/10.1200/JOP.2012.000543
        • Baumgart J.
        • Nilsson K.
        • Evers A.S.
        • Kallak T.K.
        • Poromaa I.S.
        Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer.
        Menopause. 2013; 20: 162-168https://doi.org/10.1097/gme.0b013e31826560da
        • Foglietta J.
        • Inno A.
        • de Iuliis F.
        • et al.
        Cardiotoxicity of aromatase inhibitors in breast cancer patients.
        Clin Breast Cancer. 2017; 17: 11-17https://doi.org/10.1016/j.clbc.2016.07.003
      4. ARIMIDEX (anastrozole) [package insert]. ANI Pharmaceuticals, Baudette, MN.
        (December 2018)
      5. Epocrates.
      6. Epocrates.
      7. Epocrates.
      8. Epocrates.
      9. Epocrates.
      10. Epocrates.
        • Braithwaite R.S.
        • Chlebowski R.T.
        • Lau J.
        • George S.
        • Hess R.
        • Col N.F.
        Meta-analysis of vascular and neoplastic events associated with tamoxifen.
        J Gen Int Med. 2003; 18: 937-947https://doi.org/10.1046/j.1525-1497.2003.20724.x
        • Fisher B.
        • Costantino J.P.
        • Wickerham D.L.
        • et al.
        Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.
        J Natl Cancer Inst. 1998; 90: 1371-1388https://doi.org/10.1093/jnci/90.18.1371
        • The BIG 1-98 Collaborative Group
        Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer.
        New Engl J Med. 2009; 361: 766-776https://doi.org/10.1056/NEJMoa0810818
        • Cuzick J.
        • Forbes J.F.
        • Sestak I.
        • et al.
        Long-term results of tamoxifen prophylaxis for breast cancer—96-month follow-up of the randomized IBIS-I trial.
        J Natl Cancer Inst. 2007; 99: 272-282https://doi.org/10.1093/jnci/djk049

      Biography

      Jeanne F. Noe, PharmD, BCOP, is an independent consultant pharmacist, Chapel Hill, NC.

      Biography

      Margaret A. Bush, PhD, BCOP, is an associate professor, Duke University School of Nursing, Durham, NC. She can be contacted at [email protected] .