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1.  Treatment of Bone Metastases in Patients with Advanced Breast Cancer 
Breast Care  2012;7(2):92-98.
Bone metastases are usually associated with a variety of skeletal related events (SREs), a term covering both complications (pathological fractures, spinal cord compression) and the need for therapeutic intervention (radiotherapy, surgery to bone) for painful bone lesions and/or lesions carrying a high risk of fracture by which the patient's quality of life, functioning, and independence may be compromised. In view of the availability of improved therapeutic approaches for oncological diseases and the resulting improvements of median overall survival, the aim of preventing and delaying the occurrence of SREs becomes more important. To avoid, wherever possible, therapies requiring hospitalization, is another relevant goal. In recent years, bisphosphonates, along with available tumor-specific medication (chemotherapy, hormone therapy), constituted the standard of care for preventing skeletal complications in treating patients with bone metastases. Recently, a therapeutical alternative with potentially superior efficacy has been found in denosumab, a fully human monoclonal antibody that binds to the receptor activator of nuclear factor-κB ligand (RANKL), thus preventing osteoclast-mediated bone resorption and specifically interfering with bone metabolism.
PMCID: PMC3376361  PMID: 22740794
Breast Cancer; Metastatic bone disease; Bisphosphonates; Denosumab; Osteonecrosis of the jaw
2.  Neoadjuvant Endocrine Therapy in Breast Cancer 
Breast Care  2008;3(5):303-308.
Women who suffer from large or locally advanced malignant breast tumors are now commonly treated with preoperative (‘neoadjuvant’) systemic therapy to improve surgical outcomes and to raise the chances for breast-conserving therapy (BCT). Until recently, chemotherapy was the treatment of choice, and primary systemic endocrine treatment was restricted to medically frail or older women with receptor-positive breast cancer. The development of modern aromatase inhibitors (Als) and their subsequent clinical evaluation in neoadjuvant trials now provides us with an alternative to chemotherapy that is thought to be equally effective, yet considerably better tolerated. Several large prospective trials have compared tamoxifen with the non-steroidal AIs letrozole and anastrozole and the steroidal Al exemestane, with improved outcomes for all AIs in terms of tumor remission and rate of BCT. A number of predictive biomarkers now also allow us to identify those tumors that most likely respond to a certain endocrine regimen.
PMCID: PMC2931101  PMID: 20824024
Neo-adjuvant; Endocrine therapy; Breast cancer
3.  Climacteric Complaints after Breast Cancer – Is HRT an Option? 
Breast Care  2008;3(3):204-209.
Systemic estrogen depletion is the mechanism of action of most endocrine treatment strategies, and a common side effect of most chemotherapy regimens that are currently used to treat invasive breast cancer. The ensuing immediate and profound decline in estrogen levels is, however, often associated with considerable climacteric complaints. While oral estrogen add-back therapy is effective in alleviating menopausal symptoms, it is feared that it might also promote tumor cell growth. This concern is largely based on circumstantial evidence from large trials in healthy women, in which hormone replacement therapy (HRT) resulted in a slight, albeit significant, increase in incident breast cancer. In breast cancer survivors, however, evidence from studies remains controversial. Despite these caveats, the severity of symptoms and the lack of effective alternatives still cause many women to opt for HRT. Nevertheless, HRT cannot generally be recommended as first-line therapy for climacteric complaints in women with a history of breast cancer. It may, however, be a valid option for selected women with climacteric symptoms refractory to previous non-hormonal treatments. In these cases, an individualized risk-benefit analysis is imperative before treatment initiation, and a treatment duration of less than 5 years with intermittent withdrawal attempts should be aimed for.
PMCID: PMC2931119  PMID: 20824041
Breast cancer; Climacteric complaints; Hormone replacement therapy (HRT)

Results 1-3 (3)