by Marie Robert, Nicholas Turner
Approximately 70% of metastatic breast cancers are oestrogen
receptor-positive and HER2-negative. International guidelines recommend
endocrine therapy as a preferred first-line treatment for oestrogen
receptor-positive, HER2-negative metastatic breast cancer, “even in the
presence of visceral disease, unless there is a visceral crisis or concern or
proof of endocrine resistance”.1 However, several studies have reported that
35–60% of patients in Europe and North America receive chemotherapy as
first-line treatment,2,3 especially younger patients and those with visceral
disease,4 even though a retrospective study suggested worse outcomes for
patients treated with chemotherapy than those treated with endocrine therapy.
