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The role of aromatase inhibitors as adjuvant therapy for early breast cancer in postmenopausal women.
Eur J Cancer. 2005 Aug; 41(12):1678-89.EJ

Abstract

For endocrine therapy of hormone-sensitive advanced breast cancer in postmenopausal women, the third-generation aromatase inhibitors, letrozole, anastrozole, and exemestane, are effective both as alternatives to tamoxifen in first-line treatment and following first-line tamoxifen failure. These three agents are currently being evaluated as adjuvant therapy of early breast cancer, again relative to the standard, tamoxifen. Three treatment strategies are under investigation: replacement of tamoxifen as adjuvant therapy for 5 years (early adjuvant therapy); sequencing of tamoxifen before or after an aromatase inhibitor during the first 5 years (early sequential adjuvant therapy); or following 5 years of tamoxifen (extended adjuvant therapy). Results of the first early adjuvant trial (Arimidex, Tamoxifen Alone or in Combination [ATAC]) demonstrated that anastrozole was significantly more effective than tamoxifen in reducing the risk of disease recurrence. Two trials sequencing 2-3 years of an aromatase inhibitor after 2-3 years of tamoxifen have also reported results. A large trial (International Collaborative Cancer Group [ICCG] trial 96) found switching to exemestane to be significantly superior to continuing on tamoxifen in disease-free survival, and in a small study (Italian Tamoxifen Arimidex [ITA] trial), similarly sequencing anastrozole after tamoxifen significantly reduced the hazard of recurrence compared with remaining on tamoxifen. Extended adjuvant therapy with 5 years of letrozole versus placebo following 5 years of tamoxifen was evaluated in the MA.17 trial. Compared with placebo, letrozole resulted in a significant improvement in disease-free survival that was irrespective of whether patients had lymph node-positive or -negative tumours. Results of these four trials emphasise the important role of aromatase inhibitors in the adjuvant setting, yet the optimal approach still needs to be defined. A number of trials further evaluating the three adjuvant treatment strategies are ongoing.

Authors+Show Affiliations

Department of Oncology, Rigshospitalet, 9 Blegdamsvej, Copenhagen DK-2100, Denmark. hmouridsen@rh.dkNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16098456

Citation

Mouridsen, Henning T., and Nicholas J. Robert. "The Role of Aromatase Inhibitors as Adjuvant Therapy for Early Breast Cancer in Postmenopausal Women." European Journal of Cancer (Oxford, England : 1990), vol. 41, no. 12, 2005, pp. 1678-89.
Mouridsen HT, Robert NJ. The role of aromatase inhibitors as adjuvant therapy for early breast cancer in postmenopausal women. Eur J Cancer. 2005;41(12):1678-89.
Mouridsen, H. T., & Robert, N. J. (2005). The role of aromatase inhibitors as adjuvant therapy for early breast cancer in postmenopausal women. European Journal of Cancer (Oxford, England : 1990), 41(12), 1678-89.
Mouridsen HT, Robert NJ. The Role of Aromatase Inhibitors as Adjuvant Therapy for Early Breast Cancer in Postmenopausal Women. Eur J Cancer. 2005;41(12):1678-89. PubMed PMID: 16098456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of aromatase inhibitors as adjuvant therapy for early breast cancer in postmenopausal women. AU - Mouridsen,Henning T, AU - Robert,Nicholas J, Y1 - 2004/11/25/ PY - 2004/09/30/received PY - 2004/10/11/accepted PY - 2005/8/16/pubmed PY - 2005/10/19/medline PY - 2005/8/16/entrez SP - 1678 EP - 89 JF - European journal of cancer (Oxford, England : 1990) JO - Eur J Cancer VL - 41 IS - 12 N2 - For endocrine therapy of hormone-sensitive advanced breast cancer in postmenopausal women, the third-generation aromatase inhibitors, letrozole, anastrozole, and exemestane, are effective both as alternatives to tamoxifen in first-line treatment and following first-line tamoxifen failure. These three agents are currently being evaluated as adjuvant therapy of early breast cancer, again relative to the standard, tamoxifen. Three treatment strategies are under investigation: replacement of tamoxifen as adjuvant therapy for 5 years (early adjuvant therapy); sequencing of tamoxifen before or after an aromatase inhibitor during the first 5 years (early sequential adjuvant therapy); or following 5 years of tamoxifen (extended adjuvant therapy). Results of the first early adjuvant trial (Arimidex, Tamoxifen Alone or in Combination [ATAC]) demonstrated that anastrozole was significantly more effective than tamoxifen in reducing the risk of disease recurrence. Two trials sequencing 2-3 years of an aromatase inhibitor after 2-3 years of tamoxifen have also reported results. A large trial (International Collaborative Cancer Group [ICCG] trial 96) found switching to exemestane to be significantly superior to continuing on tamoxifen in disease-free survival, and in a small study (Italian Tamoxifen Arimidex [ITA] trial), similarly sequencing anastrozole after tamoxifen significantly reduced the hazard of recurrence compared with remaining on tamoxifen. Extended adjuvant therapy with 5 years of letrozole versus placebo following 5 years of tamoxifen was evaluated in the MA.17 trial. Compared with placebo, letrozole resulted in a significant improvement in disease-free survival that was irrespective of whether patients had lymph node-positive or -negative tumours. Results of these four trials emphasise the important role of aromatase inhibitors in the adjuvant setting, yet the optimal approach still needs to be defined. A number of trials further evaluating the three adjuvant treatment strategies are ongoing. SN - 0959-8049 UR - https://www.unboundmedicine.com/medline/citation/16098456/The_role_of_aromatase_inhibitors_as_adjuvant_therapy_for_early_breast_cancer_in_postmenopausal_women_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-8049(04)00850-0 DB - PRIME DP - Unbound Medicine ER -