Biomaterial Database

Selective oestrogen receptor modulators, aromatase inhibitors and the female breast. 2005

Anthony Howell

CRUK Department of Medical Oncology, University of Manchester, Christie Hospital NHS Trust, Manchester, UK.

OBJECTIVE Tamoxifen has been available for over 20 years and remains the most commonly recognized endocrine therapy. This review was prompted by a wealth of new data on several newer endocrine agents, including selective oestrogen receptor modulators, aromatase inhibitors and a new oestrogen receptor antagonist, fulvestrant, which unlike the selective oestrogen receptor modulators has no oestrogen agonist effects. RESULTS Completed analysis of the 'Arimidex', Tamoxifen, Alone or in Combination trial demonstrated that anastrozole as initial adjuvant therapy significantly improved disease-free survival and time to recurrence compared with tamoxifen, as well as reducing the incidence of contralateral breast cancer deaths. The Italian Tamoxifen Anastrozole trial and the Austrian Breast and Colorectal Cancer Study Group 8/Arimidex Nolvadex 95 trial have indicated that anastrozole may also be beneficial in women who have already received 2-3 years of tamoxifen. Similarly, the Intergroup Exemestane Study demonstrated the efficacy of exemestane in this setting. Women who have completed a full 5-year course of tamoxifen may also benefit from aromatase inhibitor treatment as indicated by the MA 17 trial, which investigated letrozole as extended adjuvant therapy. Fulvestrant is effective in tamoxifen-resistant disease, and phase II trial data suggest that fulvestrant may also be effective following aromatase inhibitor failure. CONCLUSIONS The introduction of the third-generation aromatase inhibitors has caused a paradigm shift in adjuvant endocrine treatment. Research into the optimal use of selective oestrogen receptor modulators continues and the evidence base for fulvestrant, the first in a new class of endocrine agents, continues to grow, confirming its value in the treatment of hormone-responsive breast cancer.

UI	MeSH Term	Description	Entries
D009376	Neoplasms, Hormone-Dependent	Certain tumors that 1, arise in organs that are normally dependent on specific hormones and 2, are stimulated or caused to regress by manipulation of the endocrine environment.	Hormone-Dependent Neoplasms,Hormone Dependent Neoplasms,Hormone-Dependent Neoplasm,Neoplasm, Hormone-Dependent,Neoplasms, Hormone Dependent
D001943	Breast Neoplasms	Tumors or cancer of the human BREAST.	Breast Cancer,Breast Tumors,Cancer of Breast,Breast Carcinoma,Cancer of the Breast,Human Mammary Carcinoma,Malignant Neoplasm of Breast,Malignant Tumor of Breast,Mammary Cancer,Mammary Carcinoma, Human,Mammary Neoplasm, Human,Mammary Neoplasms, Human,Neoplasms, Breast,Tumors, Breast,Breast Carcinomas,Breast Malignant Neoplasm,Breast Malignant Neoplasms,Breast Malignant Tumor,Breast Malignant Tumors,Breast Neoplasm,Breast Tumor,Cancer, Breast,Cancer, Mammary,Cancers, Mammary,Carcinoma, Breast,Carcinoma, Human Mammary,Carcinomas, Breast,Carcinomas, Human Mammary,Human Mammary Carcinomas,Human Mammary Neoplasm,Human Mammary Neoplasms,Mammary Cancers,Mammary Carcinomas, Human,Neoplasm, Breast,Neoplasm, Human Mammary,Neoplasms, Human Mammary,Tumor, Breast
D004967	Estrogens	Compounds that interact with ESTROGEN RECEPTORS in target tissues to bring about the effects similar to those of ESTRADIOL. Estrogens stimulate the female reproductive organs, and the development of secondary female SEX CHARACTERISTICS. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds.	Estrogen,Estrogen Effect,Estrogen Effects,Estrogen Receptor Agonists,Estrogenic Agents,Estrogenic Compounds,Estrogenic Effect,Estrogenic Effects,Agents, Estrogenic,Agonists, Estrogen Receptor,Compounds, Estrogenic,Effects, Estrogen,Effects, Estrogenic,Receptor Agonists, Estrogen
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013629	Tamoxifen	One of the SELECTIVE ESTROGEN RECEPTOR MODULATORS with tissue-specific activities. Tamoxifen acts as an anti-estrogen (inhibiting agent) in the mammary tissue, but as an estrogen (stimulating agent) in cholesterol metabolism, bone density, and cell proliferation in the ENDOMETRIUM.	ICI-46,474,ICI-46474,ICI-47699,Nolvadex,Novaldex,Soltamox,Tamoxifen Citrate,Tomaxithen,Zitazonium,Citrate, Tamoxifen,ICI 46,474,ICI 46474,ICI 47699,ICI46,474,ICI46474,ICI47699
D017410	Practice Guidelines as Topic	Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.	Clinical Guidelines as Topic,Best Practices,Best Practice
D047072	Aromatase Inhibitors	Compounds that inhibit AROMATASE in order to reduce production of estrogenic steroid hormones.	Aromatase Inhibitor,Inhibitor, Aromatase,Inhibitors, Aromatase
D018572	Disease-Free Survival	Period after successful treatment in which there is no appearance of the symptoms or effects of the disease.	Survival, Disease-Free,Disease Free Survival,Survival, Disease Free
D020845	Selective Estrogen Receptor Modulators	A structurally diverse group of compounds distinguished from ESTROGENS by their ability to bind and activate ESTROGEN RECEPTORS but act as either an agonist or antagonist depending on the tissue type and hormonal milieu. They are classified as either first generation because they demonstrate estrogen agonist properties in the ENDOMETRIUM or second generation based on their patterns of tissue specificity. (Horm Res 1997;48:155-63)	Estrogen Receptor Modulators, Selective,SERMs,Estrogen Receptor Modulator, Selective,SERM,Selective Estrogen Receptor Modulator