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Benefit with aromatase inhibitors in the adjuvant setting for postmenopausal women with breast cancer.
MedGenMed. 2005 Aug 24; 7(3):20.M

Abstract

The third-generation aromatase inhibitors, letrozole, anastrozole, and exemestane, have been shown to be effective both as alternatives to tamoxifen in first-line treatment of hormone-sensitive advanced breast cancer in postmenopausal women and following failure of first-line tamoxifen for endocrine therapy. These 3 agents are now being investigated as adjuvant therapy of early breast cancer, as alternative or complementary treatments 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). In the first adjuvant trial (Arimidex, Tamoxifen Alone or in Combination [ATAC]), anastrozole was significantly superior to tamoxifen in reducing risk of disease recurrence, and recently, the Breast International Group (BIG) trial BIG 1-98 demonstrated the significant superiority of letrozole over tamoxifen in improving disease-free survival. A large trial (International Collaborative Cancer Group [ICCG] trial 96) investigated sequencing of 2 to 3 years of exemestane after 2 to 3 years of tamoxifen and found that switching to exemestane was significantly superior in disease-free survival compared with continuing on tamoxifen. The Arimidex or Nolvadex (ARNO) and the small ITA (Italian Tamoxifen Arimidex) trials similarly sequenced anastrozole after tamoxifen and also found that sequencing reduced the hazard of recurrence compared with remaining on tamoxifen. Trial MA.17 evaluated extended adjuvant therapy with letrozole vs placebo following 5 years of tamoxifen. Disease-free survival was significantly improved with letrozole vs placebo, irrespective of whether patients had lymph node-positive or node-negative tumors. All 3 aromatase inhibitors were generally well tolerated. Results of these trials indicate that aromatase inhibitors provide important benefits relative to tamoxifen in each of these adjuvant treatment settings, but the optimal approach still needs to be defined. Other trials continue to investigate some of these adjuvant treatment strategies.

Authors+Show Affiliations

Department of Oncology, Rigshospitalet, Copenhagen, Denmark.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16369246

Citation

Mouridsen, Henning T., and Nicholas J. Robert. "Benefit With Aromatase Inhibitors in the Adjuvant Setting for Postmenopausal Women With Breast Cancer." MedGenMed : Medscape General Medicine, vol. 7, no. 3, 2005, p. 20.
Mouridsen HT, Robert NJ. Benefit with aromatase inhibitors in the adjuvant setting for postmenopausal women with breast cancer. MedGenMed. 2005;7(3):20.
Mouridsen, H. T., & Robert, N. J. (2005). Benefit with aromatase inhibitors in the adjuvant setting for postmenopausal women with breast cancer. MedGenMed : Medscape General Medicine, 7(3), 20.
Mouridsen HT, Robert NJ. Benefit With Aromatase Inhibitors in the Adjuvant Setting for Postmenopausal Women With Breast Cancer. MedGenMed. 2005 Aug 24;7(3):20. PubMed PMID: 16369246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benefit with aromatase inhibitors in the adjuvant setting for postmenopausal women with breast cancer. AU - Mouridsen,Henning T, AU - Robert,Nicholas J, Y1 - 2005/08/24/ PY - 2005/12/22/pubmed PY - 2006/7/14/medline PY - 2005/12/22/entrez SP - 20 EP - 20 JF - MedGenMed : Medscape general medicine JO - MedGenMed VL - 7 IS - 3 N2 - The third-generation aromatase inhibitors, letrozole, anastrozole, and exemestane, have been shown to be effective both as alternatives to tamoxifen in first-line treatment of hormone-sensitive advanced breast cancer in postmenopausal women and following failure of first-line tamoxifen for endocrine therapy. These 3 agents are now being investigated as adjuvant therapy of early breast cancer, as alternative or complementary treatments 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). In the first adjuvant trial (Arimidex, Tamoxifen Alone or in Combination [ATAC]), anastrozole was significantly superior to tamoxifen in reducing risk of disease recurrence, and recently, the Breast International Group (BIG) trial BIG 1-98 demonstrated the significant superiority of letrozole over tamoxifen in improving disease-free survival. A large trial (International Collaborative Cancer Group [ICCG] trial 96) investigated sequencing of 2 to 3 years of exemestane after 2 to 3 years of tamoxifen and found that switching to exemestane was significantly superior in disease-free survival compared with continuing on tamoxifen. The Arimidex or Nolvadex (ARNO) and the small ITA (Italian Tamoxifen Arimidex) trials similarly sequenced anastrozole after tamoxifen and also found that sequencing reduced the hazard of recurrence compared with remaining on tamoxifen. Trial MA.17 evaluated extended adjuvant therapy with letrozole vs placebo following 5 years of tamoxifen. Disease-free survival was significantly improved with letrozole vs placebo, irrespective of whether patients had lymph node-positive or node-negative tumors. All 3 aromatase inhibitors were generally well tolerated. Results of these trials indicate that aromatase inhibitors provide important benefits relative to tamoxifen in each of these adjuvant treatment settings, but the optimal approach still needs to be defined. Other trials continue to investigate some of these adjuvant treatment strategies. SN - 1531-0132 UR - https://www.unboundmedicine.com/medline/citation/16369246/Benefit_with_aromatase_inhibitors_in_the_adjuvant_setting_for_postmenopausal_women_with_breast_cancer_ DB - PRIME DP - Unbound Medicine ER -