Approximately 25% of new breast cancers are diagnosed in premenopausal patients, 50%‐70% presenting as estrogen receptor‐positive (ER+) breast tumors. Five‐year adjuvant endocrine therapy (ET) with Tamoxifen is the cornerstone treatment for those patients but the evidence that up to 50% of ER + breast cancer distant recurrences develop after this time has now raised some questions. ATLAS and aTTom trials are the only two studies addressing the extension of Tamoxifen beyond 5 years in premenopausal patients. They showed significant DFS and OS benefits at a cost of increased rates of endometrial cancer and pulmonary embolus. Therefore, the selection of the patients at higher recurrence risk and hence deemed to get the most benefit from an extended endocrine therapy has become a major concern. Many clinical and genomic prognostic tools have shown validity in identifying patients at high late recurrence risk, but only the BCI prognostic score was shown to also be predictive of response to extended endocrine therapy. Nevertheless, all the evidence available on extended endocrine therapy in premenopausal patients was derived from trials in which patients were treated with tamoxifen alone and are hardly applicable to the current clinical scenario. In fact, the results of the SOFT and TEXT trials demonstrated the superiority of the addition of ovarian function suppression (OFS) and its association with the aromatase inhibitor (AI) Exemestane to Tamoxifen alone. However, the introduction in the clinical practice of AI + OFS‐based endocrine therapy for the premenopausal patients will very soon lead to an impasse since neither data exist on extended therapy after this treatment schedule nor is there an ongoing trial intended to obtain new evidence.

中文翻译：

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绝经前乳腺癌患者的扩大内分泌治疗：我们现在在哪里？

绝经前患者中大约诊断出25％的新乳腺癌，其中50％-70％表现为雌激素受体阳性（ER +）乳腺肿瘤。对于这些患者，使用他莫昔芬的五年辅助内分泌治疗（ET）是这些患者的基石疗法，但是这一时间之后高达50％的ER +乳腺癌远处复发的证据现在引起了一些疑问。ATLAS和aTTom试验是唯一的两项研究，表明绝经前患者中他莫昔芬的使用期限超过5年。他们显示出显着的DFS和OS益处，但代价是子宫内膜癌和肺栓塞的发生率增加。因此，选择具有较高复发风险并因此被认为从扩展内分泌治疗中获得最大益处的患者成为主要关注的问题。许多临床和基因组预后工具已显示出在识别高晚期复发风险患者中的有效性，但仅显示BCI预后评分还可以预测对延长内分泌治疗的反应。然而，绝经前患者扩大内分泌治疗的所有可用证据均来自于仅用他莫昔芬治疗患者的试验，并且几乎不适用于当前临床情况。实际上，SOFT和TEXT试验的结果证明了单独应用他莫昔芬对卵巢功能抑制（OFS）的附加作用及其与芳香酶抑制剂（AI）Exemestane的联合使用的优越性。然而，