Hormone-receptor positive early breast cancer: controversies in the use of adjuvant chemotherapy.

Current adjuvant treatments for operable breast cancer include chemotherapy, endocrine therapy in hormone-receptor positive tumors, and trastuzumab for HER2-positive tumors. Metanalyses of randomized trials show that in patients with hormone receptor positive breast cancer the effects of endocrine therapy and chemotherapy on survival are non-mutually exclusive. Most of these patients are therefore considered candidates to combined treatment. Recently, however, the endocrine-responsiveness of tumors has been redefined on clinical, histopathological and molecular bases. An emerging concept is that as endocrine-responsiveness increases, chemoresponsiveness decreases. In the adjuvant setting therapeutic choices are often based on small projected improvements clinical outcomes. As a consequence, the role of chemotherapy and traditional management algorithms in patients with hormone-receptor positive are being challenged. This review will address the current controversy regarding the role of adjuvant chemotherapy, including the newer anthracycline and taxanes-based programs, in these patients.