A review of exemestane in the management of breast cancer.

Breast cancer is a major health problem in developed countries. Endocrine therapy is a key component in the management of hormone receptor-positive disease. Although tamoxifen has historically been the gold standard in the first-line management of early and advanced breast cancer, the rise of third-generation aromatase inhibitors in the past decade has resulted in a major shift in endocrine therapy. Clinical trials of aromatase inhibitors including exemestane, an orally active steroidal aromatase inactivator, have demonstrated significant improvements in outcome measures compared with tamoxifen. In early breast cancer, key questions remain regarding the optimal sequence, duration and type of aromatase inhibitors, as well as their long-term safety.