Changing the gold standard in adjuvant therapy for breast cancer:from tamoxifen to aromatase inhibition.
The introduction of third generation aromatase inhibitors [anastrozole, letrozole, and exemestane] has certainly improved outcomes inpatients with early breast cancer. Although survival benefit has not been identified (except in the subpopulation of patients with lymph node positive breast cancer on the MA 17 study), the primary endpoints in all studies reached statistical significance in favor of AI. The strategy can include: replacing TAM outright after diagnosis; switching from TAM to one of the aromatase inhibitors after 2-3 years; or to add an AI after 5 years of TAM. DFS, recurrence, and the incidence of contra lateral breast cancer is influenced favorably with such an approach. The following issues remained unanswered: Will the OS be improved as well? Is the incidence of serious long-term side effects acceptable to our patients [osteoporosis, fractures, cognitive function and lipid profile changes]? What is the influence of chemotherapy on the effect of aromatase inhibitors? We still do not know the true role of AI in HER2 positive disease. Which effect do AI have in pre-menopausal women(with the use of LHRH agonists)? How long should patients after TAM be receiving AI? Several of these questions will be certainly answered with the new generation of studies, but many of these questions have just been generated with these new results.
Gltick
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Braman Family Breast Cancer Institute, UMSylvester Comprehensive Cancer Center,University of Miami School of Medicine, FL, USA. SGluck@med.miami.edu
D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077289:Letrozole; D009570:Nitriles / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use
D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane