Endocrine therapy for breast cancer in the primary care setting

A. Awan, A. Esfahani


The treatment of hormone-positive breast cancer (bca) is a rapidly evolving field. Improvement in the understanding of the mechanisms of action and resistance to anti-hormonal therapy has translated, in the past decade, into multiple practice-changing clinical trials, with the end result of increased survivorship for patients with all stages of hormone-positive cancer. The primary care physician will thus play an increasing role in the routine care, surveillance, and treatment of issues associated with anti-hormonal therapy. The aim of the present review was to provide a focused description of the issues relevant to primary care, while briefly highlighting recent advances in the field of anti-hormonal therapy.

Key Points

  • Hormone-positive bca is the most prevalent form of bca and, compared with the other subtypes, is usually associated with better survival.
  • Survivorship has significantly increased for all stages of hormone-positive bca, making the primary care physician a key player in the care of affected patients.

  • The two most common classes of anti-hormonal agents used in these patients are selective estrogen receptor modulators and aromatase inhibitors. Each class of medication is associated with signature side effects.

  • Within the past decade, multiple novel estrogen receptor blockers (for example, fulvestrant) and agents aimed at circumventing resistance to endocrine therapy [inhibitors of cyclin-dependent kinase 4/6 and of mtor (the mechanistic target of rapamycin)] have gained clinical ground. Understanding their side effects will be increasingly relevant to primary care physicians.

  • Multidisciplinary care is always encouraged in the care of cancer patients receiving anti-hormonal therapy.


Breast cancer; endocrine therapy; primary care; survivorship

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DOI: http://dx.doi.org/10.3747/co.25.4139

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)