Review

Endocrinology and hormone therapy in breast cancer: Aromatase inhibitors versus antioestrogens

Anthony Howell^1* and Mitch Dowsett²

• * Corresponding author: Anthony Howell maria.parker@christie-tr.nwest.nhs.uk

Author Affiliations

¹ CRUK Department of Medical Oncology, University of Manchester, Christie Hospital, Manchester, UK

² Academic Department of Biochemistry, Royal Marsden Hospital, London, UK

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Breast Cancer Res 2004, 6:269-274 doi:10.1186/bcr945

Published: 6 October 2004

Abstract

Endocrine therapies act by either blocking or downregulating the oestrogen receptor or by reducing oestrogen concentrations around and within the cancer cell. In postmenopausal women, oestrogen suppression is achieved by inhibition of the enzyme aromatase by aromatase inhibitors (AIs). Modern AIs (anastrozole, letrozole and exemestane) are more potent than earlier ones and suppress oestradiol levels in plasma to virtually undetectable concentrations. Recent comparisons of AIs with the most widely used oestrogen receptor blocking drug tamoxifen indicate that, in general, AIs result in increased response rates and greater durations of response. Here, we summarize data supporting the difference between the two types of treatment and attempt to account for the underlying mechanisms that favour AIs.