Bethânia Soares Dos Santos1, Cláudia Bordignon2,3, Daniela Dornelles Rosa4,5,6. 1. Oncology Unit, Clementino Fraga Filho University Hospital - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 2. Oncology Center, Hospital Moinhos de Vento, R. Tiradentes, 333, Porto Alegre, RS, 90560-030, Brazil. 3. Postgraduation program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil. 4. Oncology Center, Hospital Moinhos de Vento, R. Tiradentes, 333, Porto Alegre, RS, 90560-030, Brazil. dornellesrosa@gmail.com. 5. Postgraduation program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil. dornellesrosa@gmail.com. 6. Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, Brazil. dornellesrosa@gmail.com.
Abstract
PURPOSE OF REVIEW: The article reviews the consequences of estrogen deprivation during endocrine therapy for breast cancer and provides an update on alternative therapies for the management of symptoms. RECENT FINDINGS: Endocrine therapy has progressed substantially in recent years, and its use is recommended for all breast cancer patients expressing hormone receptors. The main adverse events of this treatment can be controlled with medications and nonpharmacological measures. Antidepressants are effective in controlling vasomotor symptoms. Vaginal discomfort can be treated with local lubricants and pelvic floor physiotherapy, which may help in sexual dysfunction. Pathophysiological mechanisms of musculoskeletal symptoms during aromatase inhibitors treatment are not well understood, but some studies evaluating treatment with duloxetine, yoga, and acupuncture have shown some benefits. For prevention of bone loss, patients with risk factors should be offered bisphosphonates or denosumab. Individualization of treatment is crucial. Consideration should be given to therapy effects on quality of life, and strategies for controlling associated symptoms should be offered.
PURPOSE OF REVIEW: The article reviews the consequences of estrogen deprivation during endocrine therapy for breast cancer and provides an update on alternative therapies for the management of symptoms. RECENT FINDINGS: Endocrine therapy has progressed substantially in recent years, and its use is recommended for all breast cancer patients expressing hormone receptors. The main adverse events of this treatment can be controlled with medications and nonpharmacological measures. Antidepressants are effective in controlling vasomotor symptoms. Vaginal discomfort can be treated with local lubricants and pelvic floor physiotherapy, which may help in sexual dysfunction. Pathophysiological mechanisms of musculoskeletal symptoms during aromatase inhibitors treatment are not well understood, but some studies evaluating treatment with duloxetine, yoga, and acupuncture have shown some benefits. For prevention of bone loss, patients with risk factors should be offered bisphosphonates or denosumab. Individualization of treatment is crucial. Consideration should be given to therapy effects on quality of life, and strategies for controlling associated symptoms should be offered.
Entities:
Keywords:
Adverse events; Breast cancer; Endocrine therapy; Estrogen deprivation; Hormone receptor (HR) positive; Luminal breast cancer
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