Breast cancer in men: should aromatase inhibitors become first-line hormonal treatment?

Breast cancer is an uncommon malignancy in men; therefore, the approach to treatment is mostly modeled on that used in females. First-line use of aromatase inhibitors (AIs) is now standard practice in hormone-sensitive metastatic breast cancer in postmenopausal females. However, tamoxifen continues to be regarded as first-line treatment in hormone-sensitive male breast cancer. This article reviews the role of second and third generation AIs as first- or second-line hormonal treatment in male patients with metastatic breast cancer. It also explores the potential use of AIs in combination with gonadotropin-releasing hormone analogs or trastuzumab suggesting that in the future this may prove a useful alternative to tamoxifen.