Should all postmenopausal patients with hormone receptor-positive breast cancer receive initial therapy with aromatase inhibitors?

Adjuvant Aromatase Inhibitor Therapy in Patients with Stage I Breast Cancer at a Regional Oncology Center in Israel: Implementation of a ‘Switching' Policy in Postmenopausal Patients after Initial Tamoxifen

“…Although it is interesting to speculate on the use of an approach with AI followed by tamoxifen to gain the advantage of an AI in terms of preventing early relapses in high-risk patients and then later the advantage of tamoxifen in terms of bone health, other than the BIG-1-98 trial there are scant additional data on the use of AI to tamoxifen switching. A recent analysis of treatment options by Aapro et al [20] reiterated that the state-of-the-art for adjuvant endocrine therapy of HR-positive postmenopausal BC remains either an AI or switching from tamoxifen to an AI in sequence, with no biologic markers yet available to guide the choice in the individual patient. A systematic review of the toxicity of AIs in adjuvant therapy trials suggested that switching from tamoxifen to AIs may be the optimal choice when balancing efficacy and toxicity [11].…”

“…Stage I BC may very well be the most challenging and important group to introduce AI therapy via switching because of the perceived and real good prognosis, and the importance of toxicity considerations [11] while stage II-III BC patients are likely to be prescribed AIs up-front. Finally, individualized molecular testing at this time does not guide the choice of endocrine therapy [20]. …”