Extended adjuvant antiestrogen therapy^1,2 with either tamoxifen or the aromatase inhibitor (AI)³ letrozole has improved survivorship in patients with breast cancer. Sledge and coauthors state, “it is arguable that antiestrogen treatments have had greater global impact than any other treatment intervention in cancer medicine.”^4(p1981) This translational research strategy⁵ of continuing adjuvant therapy for up to a decade is now considered standard of care. Most importantly, early cessation of adjuvant antiestrogen therapy at 5 years, rather than continuing, increases the risk of recurrence in patients at high risk⁶ (those with large primary tumors and multiple positive axillary lymph nodes). Clearly, the fact that occult micrometastases have not been killed but remain dormant must now be addressed therapeutically. The advantage of antiestrogen therapy is low cost, but future barriers to combining antiestrogen therapy with precision medicines (palbociclib and everolimus) is the high cost of years of treatment when conventional long-term combination adjuvant therapy is used. Additionally, there will be increases in toxic effects over antiestrogen therapy alone. Both factors conspire to undermine patient adherence, which results in stopping treatment, recurrence, and death.

扩展辅助抗雌激素治疗^{1 ，2}与他莫昔芬或芳香酶抑制剂（AI）³来曲唑在乳腺癌患者存活率提高。Sledge和合著者指出：“抗雌激素治疗在全球范围内的影响要比任何其他癌症医学干预措施来得大，这是有争议的。” ^{4 （p1981）}这种持续辅助治疗长达十年的转化研究策略⁵现在被视为护理标准。最重要的是，高风险患者在5年内提前停止辅助抗雌激素治疗而不是继续治疗会增加复发的风险⁶（那些具有较大原发肿瘤和多个阳性腋窝淋巴结的患者）。显然，隐性微转移尚未被杀死但仍处于休眠状态这一事实现在必须在治疗上加以解决。抗雌激素治疗的优点是成本低，但是当使用常规长期联合辅助治疗时，抗雌激素治疗与精密药物（palbociclib和依维莫司）结合的未来障碍是多年治疗的高昂成本。另外，与单独的抗雌激素疗法相比，毒性作用会增加。这两个因素共同影响了患者的依从性，导致停止治疗，复发和死亡。