News on the medical treatment of young women with early-stage HER2-negative breast cancer

ABSTRACT

Introduction: Breast cancer in young women represents a public health problem with specific age-related issues to be faced by both patients and their treating physicians.

Areas covered: This manuscript reviews the recent data on the medical management of young women with early-stage HER2-negative breast cancer.

Expert opinion: For women candidates to receive (neo)adjuvant chemotherapy, anthracycline- and taxane-based regimens are standard of care. In high-risk patients, dose-dense regimens should be preferred; in women with triple-negative breast cancer and BRCA mutations, the addition of platinum compounds may also be considered. Several adjuvant endocrine therapy options have become available for the treatment of premenopausal women with early-stage luminal breast cancer. Specifically, young patients at low risk of relapse may be safely spared chemotherapy: endocrine therapy alone with tamoxifen for 5 years is the most appropriate treatment. In women at higher risk of relapse, ovarian function suppression is therapeutic: in this scenario, luteinizing hormone-releasing hormone agonists (LHRHa) should be considered in addition to tamoxifen or aromatase inhibitors. To women concerned about the possible risk of chemotherapy-induced premature ovarian failure, the use of temporary ovarian suppression with LHRHa should be proposed as a valid strategy to potentially preserve ovarian function and fertility.

KEYWORDS:

• Breast cancer
• young women
• (neo)adjuvant therapy
• chemotherapy
• endocrine therapy
• ovarian function preservation

Article highlights

• Specific age-related issues should be faced by both women and their physicians in the treatment of breast cancer in young women.

• In 2015, several studies provided important insights for improving the medical management of young patients with early-stage HER2-negative breast cancer.

• For women candidates to receive (neo)adjuvant chemotherapy, anthracycline- and taxane-based regimens are standard of care: dose-dense regimens should be considered the preferred treatment option in young women at high risk of relapse (i.e. node positive, high grade/proliferative tumors) with both hormone receptor-positive and negative disease.

• In patients with triple-negative breast cancer and BRCA mutations, the addition of platinum compounds may be also considered.

• Young patients with hormone-receptor positive breast cancer at low risk of relapse may be safely spared chemotherapy: in this scenario, endocrine therapy alone with tamoxifen for 5 years is the most appropriate treatment.

• In women at higher risk of relapse, for example those women who are candidates to (neo)adjuvant chemotherapy, ovarian function suppression is therapeutic: in this scenario, luteinizing hormone-releasing hormone agonists (LHRHa) should be considered in addition to tamoxifen or aromatase inhibitors.

• For women who are candidates to chemotherapy and are concerned about the risk of treatment-induced premature ovarian failure, the use of temporary ovarian suppression with LHRHa should be proposed as a valid strategy to potentially preserve ovarian function and fertility.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.