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Choosing early adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer: aromatase inhibitors versus tamoxifen.
Eur J Surg Oncol. 2008 Jul; 34(7):746-55.EJ

Abstract

AIMS

The aromatase inhibitors (AIs) anastrozole, exemestane, and letrozole have demonstrated superior disease-free survival (DFS) over tamoxifen in several trials. As the choice of adjuvant endocrine treatment for early breast cancer (EBC) is evolving from tamoxifen to the AIs, this review compares the AIs with tamoxifen to help surgeons choose a treatment plan that provides the greatest reduction of recurrence risk for their patients.

METHODS

MEDLINE was searched to identify relevant literature on the adjuvant use of tamoxifen and AIs in EBC.

RESULTS

Despite the use of adjuvant tamoxifen, recurrence is a persistent threat to women with hormone-sensitive EBC. Trials of the AIs versus tamoxifen have established that patients benefit from longer DFS, and in some cases distant DFS, after the use of an AI as initial adjuvant therapy, as switch therapy following 2-3 years of tamoxifen, or as extended adjuvant therapy following 5 years of tamoxifen. The AIs are well tolerated, with a different safety profile than that of tamoxifen in all these settings. Trials addressing the optimal regimen and treatment duration for AIs are also underway.

CONCLUSIONS

The advantage in DFS associated with AIs over tamoxifen use should prompt physicians and patients to consider the use of an AI as the initial adjuvant endocrine therapy or, alternatively, switching patients who currently take tamoxifen to an AI for the remainder of adjuvant endocrine therapy. Prolonging the period of adjuvant therapy with letrozole after 5 years of tamoxifen reduces recurrence and is associated with a survival advantage in node-positive patients.

Authors+Show Affiliations

St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. robert.carpenter@bartsandthelondon.nhs.uk

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

18296017

Citation

Carpenter, R. "Choosing Early Adjuvant Therapy for Postmenopausal Women With Hormone-sensitive Breast Cancer: Aromatase Inhibitors Versus Tamoxifen." European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, vol. 34, no. 7, 2008, pp. 746-55.
Carpenter R. Choosing early adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer: aromatase inhibitors versus tamoxifen. Eur J Surg Oncol. 2008;34(7):746-55.
Carpenter, R. (2008). Choosing early adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer: aromatase inhibitors versus tamoxifen. European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 34(7), 746-55. https://doi.org/10.1016/j.ejso.2008.01.011
Carpenter R. Choosing Early Adjuvant Therapy for Postmenopausal Women With Hormone-sensitive Breast Cancer: Aromatase Inhibitors Versus Tamoxifen. Eur J Surg Oncol. 2008;34(7):746-55. PubMed PMID: 18296017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Choosing early adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer: aromatase inhibitors versus tamoxifen. A1 - Carpenter,R, Y1 - 2008/03/04/ PY - 2007/07/13/received PY - 2008/01/09/accepted PY - 2008/2/26/pubmed PY - 2008/7/4/medline PY - 2008/2/26/entrez SP - 746 EP - 55 JF - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology JO - Eur J Surg Oncol VL - 34 IS - 7 N2 - AIMS: The aromatase inhibitors (AIs) anastrozole, exemestane, and letrozole have demonstrated superior disease-free survival (DFS) over tamoxifen in several trials. As the choice of adjuvant endocrine treatment for early breast cancer (EBC) is evolving from tamoxifen to the AIs, this review compares the AIs with tamoxifen to help surgeons choose a treatment plan that provides the greatest reduction of recurrence risk for their patients. METHODS: MEDLINE was searched to identify relevant literature on the adjuvant use of tamoxifen and AIs in EBC. RESULTS: Despite the use of adjuvant tamoxifen, recurrence is a persistent threat to women with hormone-sensitive EBC. Trials of the AIs versus tamoxifen have established that patients benefit from longer DFS, and in some cases distant DFS, after the use of an AI as initial adjuvant therapy, as switch therapy following 2-3 years of tamoxifen, or as extended adjuvant therapy following 5 years of tamoxifen. The AIs are well tolerated, with a different safety profile than that of tamoxifen in all these settings. Trials addressing the optimal regimen and treatment duration for AIs are also underway. CONCLUSIONS: The advantage in DFS associated with AIs over tamoxifen use should prompt physicians and patients to consider the use of an AI as the initial adjuvant endocrine therapy or, alternatively, switching patients who currently take tamoxifen to an AI for the remainder of adjuvant endocrine therapy. Prolonging the period of adjuvant therapy with letrozole after 5 years of tamoxifen reduces recurrence and is associated with a survival advantage in node-positive patients. SN - 1532-2157 UR - https://www.unboundmedicine.com/medline/citation/18296017/Choosing_early_adjuvant_therapy_for_postmenopausal_women_with_hormone_sensitive_breast_cancer:_aromatase_inhibitors_versus_tamoxifen_ DB - PRIME DP - Unbound Medicine ER -