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. 2015 Aug;40(8):511–520.

Table 1.

Hormonal Therapies for HR+ Breast Cancer, by Year of Initial FDA Approval

Drug Initial FDA Approval Class Indications
Fulvestrant (Faslodex, AstraZeneca) 2002 ER antagonist

  • HR+ metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy (i.e., tamoxifen or toremifene)
Exemestane (Aromasin, Pfizer)* 1999 Aromatase inactivator (steroidal)

  • Adjuvant treatment of postmenopausal women with ER+ early breast cancer who have received 2 to 3 years of tamoxifen and are switched to exemestane for completion of a total of 5 consecutive years of adjuvant hormonal therapy

  • Advanced breast cancer in postmenopausal women whose disease has progressed following tamoxifen therapy
Letrozole (Femara, Novartis)* 1997 Aromatase inhibitor (nonsteroidal)

  • Adjuvant treatment of postmenopausal women with HR+ early breast cancer

  • Extended adjuvant treatment of early breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen therapy

  • First-line treatment of postmenopausal women with HR+ or unknown, locally advanced or metastatic breast cancer

  • Treatment of advanced breast cancer in postmenopausal women with disease progression following antiestrogen therapy
Toremifene (Fareston, ProStrakan) 1997 SERM

  • Metastatic breast cancer in postmenopausal women with ER+ or unknown tumors
Anastrozole (Arimidex, AstraZeneca)* 1995 Aromatase inhibitor (nonsteroidal)

  • Adjuvant treatment of postmenopausal women with HR+ early breast cancer

  • First-line treatment of postmenopausal women with HR+ or HR unknown locally advanced or metastatic breast cancer

  • Advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy
Tamoxifen (Nolvadex, AstraZeneca)* 1977 SERM

  • Metastatic breast cancer in women and men; in premenopausal women with metastatic breast cancer, tamoxifen is alternative to oophorectomy or ovarian irradiation

  • Adjuvant treatment of node-positive or node-negative breast cancer following total or segmental mastectomy, axillary dissection, and breast irradiation
*

Generic versions available

SERM = selective estrogen receptor modulator