Systemic Therapies to Reduce the Risk of Recurrence in Early Breast Cancer: New Strategies

The systemic adjuvant treatment of early breast cancer (EBC) has benefited from a multifaceted approach. Generic cytotoxic approaches, as well as a more targeted approach to the estrogen receptor or HER2 receptor are now established standards of care. Decades of innovative trials exploring bisphosphonates in breast cancer prevention and EBC for bone protection, as well as large prospective randomized trials have resulted in an overwhelming case for benefit in post menopausal women. Therapies such as everolimus and the PARP inhibitors, established in the secondary breast cancer setting, are being explored in the adjuvant setting for utility. Similarly, observational and retrospective studies have demonstrated a strong reduction in breast cancer risk with the use of metformin and aspirin, and hence large prospective randomized trials are underway.