Sequencing of Endocrine Therapy in Postmenopausal Women with Advanced Breast Cancer

James N. Ingle, Steven Come, Matthew Ellis, Richard Santen, Mina Bissell, Rachel Schiff, Paul Goss

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


The introduction of the nonsteroidal aromatase inhibitor (NS-AI) anastrozole as an alternative to tamoxifen for adjuvant therapy of women with resected hormone receptor-positive breast cancer has added a management category into which patients presenting with metastatic disease can be placed. There are now essentially three such categories: (a) tamoxifen sensitive (no prior AI); (b) tamoxifen resistant (no prior AI); and (c) NS-AI resistant (no prior tamoxifen). Well-conducted Phase III trials provide evidence for choosing first-line therapy for advanced disease in categories a and b. In tamoxifen-sensitive patients, one can choose either NS-AI, anastrozole, or letrozole. In tamoxifen-resistant patients, one can choose either of the NS-AIs, the steroidal AI exemestane, or the estrogen receptor down-regulator fulvestrant. The situation is quite different for patients in category c. There are no Phase III trials of agents in patients who have experienced disease progression on a NS-AI. Phase II data are available for exemestane and high-dose estrogens, and retrospective data are available for tamoxifen and fulvestrant. Additional clinical trials are needed to determine an optimal sequencing strategy.

Original languageEnglish (US)
Pages (from-to)362s-367s
JournalClinical Cancer Research
Issue number1 II
StatePublished - Jan 28 2004

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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