title: Clinical and economic benefits of aromatase inhibitor therapy in early-stage breast cancer.
abstract: OBJECTIVE
  The clinical and economic benefits of aromatase inhibitor (AI) therapy in early-stage breast cancer are reviewed.
  
  
  CONCLUSIONS
  AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer, as it significantly reduces the risk of disease recurrence and death. Using the currently accepted gold standard for clinical efficacy-improvement in disease-free survival rather than overall survival-exemestane, anastrozole, or letrozole as monotherapy or in sequence with tamoxifen has been found to be superior to tamoxifen monotherapy. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. Of the nonsteroidal AIs, letrozole appears to have the efficacy advantage by demonstrating an early effect on distant recurrence and, subsequently, a potentially significant overall survival benefit, though results of a prospective head-to-head trial of anastrozole and letrozole are not yet available. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence. However, preliminary analyses indicate that the survival benefit appears to be greater with letrozole than with anastrozole. Thus, considering potential survival benefits and cost-effectiveness, letrozole may be preferable to anastrozole in the early adjuvant setting.
  
  
  CONCLUSIONS
  AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence.
authors: Division of Hematology–Oncology, Leonard M. Miller School of Medicine, University of Miami, FL, USA. sgluck@med.miami.edu
authors: Stefan
authors: S
authors: Glück
authors: Fariborz
authors: F
authors: Gorouhi
mesh_terms: D000077384:Anastrozole; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D000077289:Letrozole; D009570:Nitriles / Q000191:economics / Q000627:therapeutic use; D017698:Postmenopause; D016019:Survival Analysis; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane