American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for women with hormone receptor-positive breast cancer: status report 2002.
OBJECTIVE
To conduct an evidence-based technology assessment to determine whether the routine use of anastrozole or any of the aromatase inhibitors in the adjuvant breast cancer setting is appropriate for broad-based conventional use in clinical practice. POTENTIAL INTERVENTIONS: Anastrozole, letrozole, and exemestane.


RESULTS
Outcomes of interest include breast cancer incidence, breast cancer-specific survival, overall survival, and net health benefit.


METHODS
A comprehensive, formal literature review was conducted for relevant topics and is detailed in the text. Testimony was collected from invited experts and interested parties. The American Society of Clinical Oncology (ASCO)-prescribed technology assessment procedure was followed. BENEFITS/HARMS: The ASCO panel recognizes that a woman and her physician's decision regarding adjuvant hormonal therapy is complex and will depend on the importance and weight attributed to information regarding both cancer and non-cancer-related risks and benefits.


CONCLUSIONS
The panel was influenced by the compelling, extensive, and long-term data available on tamoxifen. Overall, the panel considers the results of the Arimidex (anastrozole) or Tamoxifen Alone or in Combination (ATAC) trial and the extensive supporting data to be very promising but insufficient to change the standard practice at this time (May 2002). A 5-year course of adjuvant tamoxifen remains the standard therapy for women with hormone receptor-positive breast cancer. The panel recommends that physicians discuss the available information with patients, and, in making a decision, acknowledge that treatment approaches can change over time. Individual health care providers and their patients will need to come to their own conclusions, with careful consideration of all of the available data. (Specific questions addressed by the panel are summarized in Appendix 3.)


RESULTS
The conclusions of the panel were endorsed by the ASCO Health Services Research Committee and the ASCO Board of Directors.
Winer
Eric P
EP
Health Services Research Department, American Society of Clinical Oncology, 1900 Duke Street, Suite 200, Alexandria, VA 22314, USA. guidelines@asco.org
Hudis
Clifford
C
Burstein
Harold J
HJ
Chlebowski
Rowan T
RT
Ingle
James N
JN
Edge
Stephen B
SB
Mamounas
Eleftherios P
EP
Gralow
Julie
J
Goldstein
Lori J
LJ
Pritchard
Kathleen I
KI
Braun
Susan
S
Cobleigh
Melody A
MA
Langer
Amy S
AS
Perotti
Judy
J
Powles
Trevor J
TJ
Whelan
Timothy J
TJ
Browman
George P
GP
D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000201:enzymology* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005104:Expert Testimony; D005260:Female; D006801:Humans; D009570:Nitriles / Q000627:therapeutic use*; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole