Abstract：
After decades of research, improving the efficacy of adjuvant endocrine therapy (ET) for early-stage breast cancer becomes increasingly difficult. Beyond technological breakthroughs and the availability of new classes of drugs, further improvement of adjuvant ET will require applying a rigorous research approach in poorly investigated areas. We critically discuss some key principles that should inform future research to improve ET efficacy, including identifying specific subgroups of patients who can benefit from escalating or de-escalating approaches, optimizing available and new treatment strategies for different clinical contexts, and dissecting the direct and indirect biological effects of therapeutic interventions. Four main issues regarding adjuvant ET were identified as relevant areas, where a better application of such principles can provide positive results in the near future: (i) tailoring the optimal duration of adjuvant ET, (ii) optimizing ovarian function suppression for premenopausal women, (iii) dissecting the biological effects of estrogen receptor manipulation, and (iv) refining the selection of patients to candidate for treatments escalation.
摘要：
经过几十年的研究,提高早期乳腺癌辅助内分泌治疗(ET)的疗效变得越来越困难.除了技术突破和新型药物的可获得性，佐剂ET的进一步改善将需要在研究不足的领域应用严格的研究方法。我们批判性地讨论了一些关键原则，这些原则应该为未来的研究提供信息，以提高ET的疗效。包括确定可以从升级或降级方法中受益的特定患者亚组，针对不同的临床环境优化可用和新的治疗策略，并剖析治疗干预措施的直接和间接生物学效应。关于佐剂ET的四个主要问题被确定为相关领域，其中，更好地应用这些原理可以在不久的将来提供积极的结果：（i）调整佐剂ET的最佳持续时间，（ii）优化绝经前妇女的卵巢功能抑制，（iii）剖析雌激素受体操纵的生物学效应，和（iv）完善患者的选择以进行治疗升级。
