Management of patients with hormone receptor–positive breast cancer with visceral disease: challenges and treatment options

Abstract

Endocrine therapy is an important treatment option for women with hormone receptor–positive (HR+) advanced breast cancer (ABC), yet many tumors are either intrinsically resistant or develop resistance to these therapies. Treatment of patients with ABC presenting with visceral metastases, which is associated with a poor prognosis, is also problematic. There is an unmet need for effective treatments for this patient population. Although chemotherapy is commonly perceived to be more effective than endocrine therapy in managing visceral metastases, patients who are not in visceral crisis might benefit from endocrine therapy, avoiding chemotherapy-associated toxicities that might affect quality of life. To improve outcomes, several targeted therapies are being investigated in combination with endocrine therapy for patients with endocrine-resistant, HR+ ABC. Although available data have considered patients with HR+ ABC as a whole, there are promising data from a prespecified analysis of a Phase III study of everolimus (Afinitor®), a mammalian target of rapamycin (mTOR) inhibitor, in combination with exemestane (Aromasin®) in patients with visceral disease progressing after nonsteroidal aromatase inhibitor therapy. In this review, challenges and treatment options for management of HR+ ABC with visceral disease, including consideration of therapeutic approaches undergoing clinical investigation, will be assessed.

Clinical considerations of the role of palbociclib in the management of advanced breast cancer patients with and without visceral metastases

“…Many women with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2−) ABC present with visceral metastases, and their prognosis is generally worse than those without visceral involvement [ 1 ]. Endocrine therapy (ET) is an effective strategy to manage HR+/HER2− ABC, and sequential ET is the preferred treatment option for patients without immediately life-threatening diseases or rapidly progressing visceral metastases [ 2–4 ].…”

“…Chemotherapy should be considered for any symptomatic visceral crisis, but otherwise treatment guidelines recommend three sequential ET regimens until no clinical benefit is evident or symptomatic visceral disease occurs [ 4 ], for the purpose of delaying the use of chemotherapy as long as possible. Despite this, many patients with visceral disease who are not in visceral crisis receive chemotherapy as early-line treatment [ 1 , 5 ], although it may be generally associated with worse tolerability [ 6 ] and poorer QoL compared with ET [ 7 ].…”

A method for establishing a patient-derived xenograft model to explore new therapeutic strategies for esophageal squamous cell carcinoma

“…Hence, the key factors of signaling pathways can be effective therapeutic targets for the treatment of ESCC. Unlike breast cancer and non-small cell lung cancer (5)(6)(7)(8), there is no reported data concerning the targeted therapy of ESCC. Therefore, there is needed to develop an effective strategy to investigate the mechanisms of esophageal carcinogenesis and explore therapeutic strategies for specific individuals to improve the prognosis of esophageal patients.…”

New insights into patterns of first metastatic sites influencing survival of patients with hormone receptor-positive, HER2-negative breast cancer: a multicenter study of 271 patients

“…Despite advancements in adjuvant therapy, some early breast cancer patients experience distant metastasis and are generally incurable, leading to poor prognosis [3,4]. Most such cases are the HR+/HER2-breast cancer subtype [5,6]. Therefore, it is important to assess clinicopathological factors associated with the prognosis of the major subtype, which helps us identify appropriate therapeutic strategies.…”

“…Breast cancer is the most commonly diagnosed cancer in women and causes cancer-related mortality worldwide [1,2]. Despite recent improvements in adjuvant treatment, 20-30% of early breast cancer patients will develop distant metastasis and be generally incurable, in which cases the main treatment goal is symptom palliation, and more than 70% of the patients present with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer [3][4][5][6]. According to current guidelines and international consensus statements, the metastatic patterns of first metastatic sites are important determinants of the initial therapeutic strategy for HR+/HER2-metastatic patients [7][8][9].…”