Are SOFT and TEXT results practice changing and how?

- In low risk patients tamoxifen alone can still be considered the standard of care.
- OFS indicated if sufficient risk to deserve chemotherapy, particularly if < 35 years.
- When OFS is indicated, exemestane further improves short-term outcomes.
- Side effects are more frequent with OFS + oral therapy than with tamoxifen alone.
- The choice of therapy should be based on individual risk and toxicity profile.

Optimal adjuvant endocrine therapy for premenopausal women with hormone-receptor positive breast cancer has long been debated. In particular, the role of ovarian function suppression in addition to standard tamoxifen divided oncologists worldwide, and more recently, the role of aromatase inhibitors as an alternative to tamoxifen in the setting of ovarian suppression became a key question.In 2014, the long awaited results of the International Breast Cancer Study Group (IBCSG) led randomized, phase 3 trials, Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT), provided additional evidence to inform the discussion.The interpretation of the SOFT and TEXT trial data can facilitate better selection of appropriate endocrine therapy according to individual disease characteristics, recognizing the complexity of the puzzle, which is still not complete.