Teaching pack: Hormonal Therapy

Aromatase inhibitors, SERMs, SERDs (fulvestrant, oral SERDs, PROTAC degraders like vepdegestrant), ovarian suppression, androgen deprivation, and AR pathway inhibitors. Combined with CDK4/6, PI3K/AKT, or PARP inhibitors depending on the tumour.

• Androgen deprivation & AR pathway inhibitors: Androgen deprivation lowers testosterone or blocks its receptor, and has been the foundation of prostate cancer treatment since 1941 (Nobel Prize 1966).
• CDK4/6 inhibitors: Pills that stop the cell-division engine, added to hormone therapy for the most common type of breast cancer.
• Dietitian-led weight-loss programmes in HR-positive breast cancer: Being overweight after breast cancer is linked with more recurrence, so a 3,000-woman trial tested a two-year telephone weight-loss programme. Women lost weight, but the trial did not clearly show fewer recurrences.
• Endocrine therapy (SERMs, AIs, SERDs): Pills that block or remove oestrogen signalling, the mainstay of treatment for hormone-driven breast cancer for 50 years.
• Fertility-sparing hormonal treatment of early endometrial cancer: For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.
• Soy foods and breast cancer: For years women with breast cancer were told to avoid soy because it contains plant oestrogens. Large studies show moderate soy food intake is safe and may slightly reduce recurrence, including on tamoxifen.

• SOFT & TEXT (phase 3, n=5,738): 12-year disease-free survival (TEXT+SOFT): 80.5% vs 75.9%, HR 0.79
• BWEL (Breast Cancer Weight Loss, Alliance A011401) (phase 3, n=3,181): Weight loss achieved; primary iDFS endpoint not met at first analysis (presented 2025; publication pending, verify).
• WHEL (Women's Healthy Eating and Living) (phase 3, n=3,088): Invasive breast cancer event (recurrence or new primary): 16.7% vs 16.9%, HR 0.96