Indications.
Hormone receptor (ER and/or PgR)-positive breast cancer.
Adverse effects of endocrine therapy :
Hot flashes, night sweats, musculoskeletal symptoms, osteoporosis, increased incidence of fractures, uterine cancer and increased incidence of deep vein thrombosis;
Order of endocrine therapy and other adjuvant treatments.
Adjuvant endocrine therapy applied simultaneously with chemotherapy may reduce the efficacy. It is usually applied after chemotherapy, but it can be applied simultaneously with radiation therapy and Herceptin therapy.
Adjuvant endocrine therapy regimen and precautions for premenopausal patients
The first choice is triamcinolone acetonide 20 mg/d x 5 years. Contraception during treatment and annual gynecologic examinations.
Ovarian debulking is recommended for premenopausal patients in the following groups.
1. Patients in the high risk group and whose chemotherapy has not resulted in amenorrhea should also be combined with triamcinolone acetonide. Ovarian denervation can also be combined with third-generation aromatase inhibitors, but there is insufficient evidence to show its superiority over the combination of ovarian denervation with triamcinolone acetonide.
2, Patients in the moderate risk group who are not willing to receive adjuvant chemotherapy while in combination with triamcinolone acetonide.
3, Those with contraindications to triamcinolone acetonide. If pharmacologic ovarian debulking is used, the current recommended duration of treatment is 2 to 3 years
Protocols and considerations for adjuvant endocrine therapy in postmenopausal patients
Third-generation aromatase inhibitors should be recommended for all ER and/or PgR-positive patients, especially those with the following factors.
1. High risk patients ;
2, Patients with Her-2 overexpression;
3, Patients with contraindications to triamcinolone; or patients with moderate or severe adverse effects during the use of triamcinolone.
4.Patients with moderate or severe adverse reactions during the use of triamcinolone.
5. Patients at high risk after 20 mg/d of triamcinolone x 5 years
Aromatase inhibitors can be applied for 5 years from the beginning, or transferred for 2-3 years after 2-3 years of triamcinolone therapy, or continued for 5 years in high-risk patients after 5 years of triamcinolone use.