Are we Ready to Change Clinical Practice after the ‘Soft and Text’ Results?

Abstract

Keywords• aromatase inhibitors • breast cancer • exemestane • triptorelin Luminal breast cancer is the most common subtype among molecular subgroups of breast cancer identified by gene profiling, and it accounts for more than half of all breast cancer cases around the world [1].These cancers are characterized by hormonal receptors and low proliferative activity; in particular luminal A (high rate of estrogen and progesterone receptors, low proliferative index, low grading) is the breast cancer type with the best prognosis, while luminal B can be further subclassified into two phenotypes, depending on the expression of HER2 (luminal B HER2 positive or luminal B HER2 negative). Luminal B is characterized by low rate of estrogen and progesterone receptors and high proliferative index [2].The breast cancer incidence has increased in the last years, especially among younger women [3]. The treatment of premenopausal women involves all the problems correlated to fertility preservation, an important issue for every woman affected by cancer [3,4].The gold standard treatment for premenopausal women with hormone receptors positive early breast cancer is tamoxifen for 5 years, with or without ovarian suppression, which has demonstrated a significant effect on overall survival (OS) and in the reduction of relapses [5].However, the association of ovarian suppression with aromatase inhibitors has emerged as a valid alternative in the adjuvant setting for premenopausal patients. The Phase III SOFT and TEXT trials conducted by the International Breast Cancer Study Group (IBCSG) in collaboration with the Breast International Group (BIG) and the North American Breast Cancer Group (NABCG), involved 4690 patients in 27 countries across six continents [6]. These researchers demonstrated, for the first time, the superiority of exemestane in combination with the gonadotropin-releasing hormone analogue (GnRH-A) triptorelin, over tamoxifen plus ovarian suppression in the prevention of recurrence in young premenopausal women with hormone-sensitive early-stage breast cancer [6].Exemestane and triptorelin treatment determined a decrease of 28% in the relative risk of developing a recurrence, with a disease-free survival (DFS) at 5 years of 91.1%, compared with 87.3% in the tamoxifen group [6]. Despite the significant improvement in DFS, an improvement in OS has not been demonstrated in

Treatment of HER2+ metastatic salivary ductal carcinoma in a pregnant woman: a case report

“…In breast cancer, endocrine therapy is used in hormone receptor-positive disease. In this setting, gonadotropin-releasing hormone agonists (GnRH) inhibit cancer proliferation and may confer a survival benefit in premenopausal patients [8]. Even though our case did not overexpress hormone receptors (estrogen and progesterone), we decided to associate triptorelin in combination with anti-HER2-based systemic therapy.…”