3.1 Tamoxifen, aromatase inhibitors or fulvestrant are reasonable choices for patients with postmenopausal relapse who have not received antiestrogenic therapy or have no longer relapse. Postmenopausal recurrent metastatic breast cancer, the first choice for first-line endocrine therapy is the third-generation aromatase inhibitors, including anastrozole, letrozole, and exemestane, because of relapsed mammary gland failure in tamoxifen treatment In the second-line treatment of cancer, the third-generation aromatase inhibitor is more effective than megestrol. In the first-line endocrine therapy of recurrent metastatic breast cancer, the third-generation aromatase inhibitor was significantly better than tamoxifen. Chemotherapy is preferred in patients with pre-menopausal recurrent metastatic breast cancer. If hormone receptor-positive patients are suitable or need to be treated with aromatase inhibitors for endocrine therapy, bilateral oophorectomy is preferred, followed by aromatase inhibitors. Drug-induced ovarian function inhibition combined with aromatase inhibitors are also a consideration (but there is no clinical evidence).
3.2 Postmenopausal patients, first-line endocrine therapy can choose aromatase inhibition, fulvestrant, tamoxifen or toremifene. Aromatase inhibitors are usually preferred, contraindications for treatment with aromatase inhibitors, adjuvant endocrine therapy with aromatase inhibitors, short-lived disease-free survival, or inability to accept aromatase inhibitors for economic reasons Patients, consider giving tamoxifen or toremifene.
3.3 Another type of aromatase inhibitor can be used. If the treatment of non-steroidal aromatase inhibitors (letrozole, anastrozole) fails, consider switching to a steroidal aromatase to inhibit exemestane, and vice versa.