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| |  Switching to an Aromatase Inhibitor at Year 5 of Tamoxifen Therapy Reduces Breast Cancer Recurrence: Presented at SABCS By Jennifer Reising SAN ANTONIO, Tex -- December 14, 2009 -- Switching to an aromatase inhibitor (AI) at year 5 of tamoxifen therapy, instead of stopping treatment, has a highly significant reduction in breast cancer recurrence among postmenopausal women with early-stage, oestrogen receptor (ER)-positive breast cancer, researchers said here at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS). “This meta-analysis basically confirms that, out of 4 global trials involving a large number of women, delayed aromatase inhibitor therapy significantly benefits ER-positive breast cancer patients,” said Paul Goss, MD, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, on December 12. A meta-analysis of outcomes data was conducted for 4 clinical trials: National Cancer Institute of Canada (NCIC) Clinical Trials Group (CTG) MA 17; National Surgical Adjuvant Breast and Bowel Project (NSABP) B33; Austrian Breast & Colorectal Cancer Study Group (ABCSG) VIA; and the Adjuvant Post-Tamoxifen Exemestane Versus Nothing Applied (ATENA) study. The primary analysis involved patients with tumours reported to be ER-positive with endpoints of first breast cancer recurrence (all, local only, contralateral only, distant), death with or without recurrence, or any death. Two clinical trials, the MA 17 and B33 trials, were stopped early. Follow-up data for the MA 17 study were concealed at the date of unblinding, however this was not possible with the B33 study, which consequently includes some events following subsequent treatment crossovers. At a median follow-up of 2.5 years, aromatase inhibitor therapy was associated with an absolute 2.9% (standard error [SE] 0.5) decrease and a relative decrease of 43% (SE 8) in breast cancer recurrence (P < .00001). There was an absolute 0.5% (SE 0.3) decrease and a relative decrease of 27% (SE 17), in breast cancer mortality (P = .11) The meta-analysis shows a trend towards improved survival; however, the magnitude of the effect seen on disease-free and overall survival is likely to be underestimated because of some crossover after the unblinding of the trials. “The main message here is that longer endocrine therapy is better than shorter because it’s a chronic relapsing disease in women with ER-positive breast cancer,” said Dr. Goss [Presentation title: Aromatase Inhibitors (AIs) Versus Not (Placebo/Observation) as Late Extended Adjuvant Therapy for Postmenopausal Women With Early Stage Breast Cancer (BC): Overviews of Randomized Trials of AIs After ~5 Years of Tamoxifen. Abstract 4081]
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