Joanne E. Mortimer, MD, FACP

Closing out their review of treatment strategies for HR+ metastatic breast cancer, a panel of experts highlights ongoing investigations and future directions in care.

Expert panelists consider the appropriate use of PARP and immune checkpoint inhibitors, respectively, in the setting of HR+ metastatic breast cancer.

A brief review of Trop-2 directed therapy and its role in the HR+ metastatic breast cancer treatment landscape.

Centering discussion on HER2-targeted trastuzumab deruxtecan, experts reflect on the presence of HER2-low metastatic breast cancer and optimal treatment strategies.

After briefly addressing resistance to endocrine therapy, expert panelists broadly review novel treatment modalities in the setting of HR+ metastatic breast cancer.

Expert perspectives review a case of relapsed HR+ metastatic breast cancer and consider treatment options available in the second line and beyond.

Highlights from key clinical data informing the selection of targeted therapy in particular subsets of patients with HR+ breast cancer.

Comprehensive insight to the selection of CDK4/6 inhibitors as first-line therapy for patients with metastatic HR+ breast cancer, followed by a brief review of available endocrine partners.

Centering discussion on a patient scenario of stage II HR+ breast cancer, expert panelists consider how they would approach workup and selection of therapy.

Dr. Bennett and colleagues have provided a thorough and balanced history of the rise and fall of erythropoietin-stimulating agents (ESAs) in cancer-associated anemia. Their review encourages us to think about the lessons learned from this history-lessons about medical progress, the importance of clinical research in guiding clinical practice, and the role of the US Food and Drug Administration (FDA) in protecting patients

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

Published literature indicates that the selective estrogen-receptormodulators (SERMs) tamoxifen and raloxifene (Evista) have favorableeffects on bone density, lipid profiles, and the incidence of secondbreast cancers, and unfavorable effects on the incidence of venousthrombosis and hot flushes. Tamoxifen increases the risk of endometrialcancer, but raloxifene does not. The effects of SERMs on sexualfunction and cognition are unclear. Because the selective antiaromataseagents are relatively new, the long-term effects of these agentson normal tissues are less well established. It appears that the nonsteroidalagents (anastrozole [Arimidex], letrozole [Femara]) and steroidal(exemestane [Aromasin]) antiaromatase agents may have differenteffects on normal tissues. Preliminary data demonstrate that anastrozoleincreases the risk of arthralgias and produces a decrease in bonedensity. In contrast, exemestane appears to favorably affect bonedensity and lipid profile, similar to tamoxifen and raloxifene. Theincidence of contralateral breast cancer is decreased in women onadjuvant anastrozole, but data for the other antiaromatase agents arenot yet available. Hot flushes have been reported with the use ofselective aromatase inhibitors, but their incidence seems to be comparableto what is reported with SERMs. Antiaromatase agents do notappear to cause venous thrombosis. More information about the effectsof the antiaromatase agents on normal tissue will become available asdata from ongoing adjuvant and chemoprevention trials are reported.Clinically, we should be conscious of the differences between antiaromataseagents and SERMs and their impact on women’s health.