title: A randomized trial exploring the biomarker effects  of neoadjuvant sequential treatment with exemestane  and anastrozole in post-menopausal women with hormone  receptor-positive breast cancer.
abstract: Several adjuvant endocrine strategies exist for postmenopausal women with breast cancer. This study compared the effect of two sequences of aromatase inhibitor use [steroidal (exemestane) and non-steroidal (anastrozole)] on serological and pathological biomarkers when given in the neoadjuvant setting to postmenopausal women with breast cancer. Thirty women were assigned to receive exemestane 25 mg or anastrozole 1 mg each given for 8 weeks in a randomized sequence. The effect of this treatment on serum estrone sulfate and estradiol levels, as well as tumor changes in the proliferation biomarker Ki67 were evaluated at baseline, 8 weeks and 16 weeks. WHO clinical response criteria, patient preference, and quality of life were also assessed. Assessable data was available from 28 patients. There were no differences in concentration changes of serum estradiol or Ki67 between patients in the two arms. Overall clinical response rate was 68% (19/28 assessable patients) and clinical benefit was 93% (26/28 assessable patients). There was no significant difference in toxicity or quality of life scores. The majority of patients expressed a personal preference for anastrozole over exemestane. Results suggest that the order of steroidal and non-steroidal aromatase inhibitors has little effect on outcome. The majority of patients express clear preferences for drug treatments.
authors.affiliation: Department of Medicine, University of Toronto, Division of Medical Oncology, Princess Margaret Hospital, Toronto, Canada. orit.freedman@utoronto.ca
authors.forename: O C
authors.initials: OC
authors.lastname: Freedman
authors.forename: E
authors.initials: E
authors.lastname: Amir
authors.forename: W
authors.initials: W
authors.lastname: Hanna
authors.forename: H
authors.initials: H
authors.lastname: Kahn
authors.forename: F
authors.initials: F
authors.lastname: O'Malley
authors.forename: G
authors.initials: G
authors.lastname: Dranitsaris
authors.forename: D E C
authors.initials: DE
authors.lastname: Cole
authors.forename: S
authors.initials: S
authors.lastname: Verma
authors.forename: E
authors.initials: E
authors.lastname: Folkerd
authors.forename: M
authors.initials: M
authors.lastname: Dowsett
authors.forename: M
authors.initials: M
authors.lastname: Clemons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism*; D049109:Cell Proliferation; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D017698:Postmenopause; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D015415:Biomarkers; D019394:Ki-67 Antigen; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole; D004958:Estradiol; C056516:exemestane