Current controversies in extended adjuvant endocrine therapy for early breast cancer

Current Opinion in Oncology

Volumn 20, Issue 6, 2008, Pages 627-633

  Snoj, Natasa ^a   Paridaens, Robert ^b   Cufer, Tanja ^a  

^a INSTITUTE OF ONCOLOGY   (Slovenia)

^b UNIVERSITY HOSPITALS LEUVEN   (Belgium)

Author keywords

Aromatase inhibitors; Breast cancer; Extended adjuvant endocrine therapy; Tamoxifen

Indexed keywords

ANASTROZOLE; AROMATASE INHIBITOR; EXEMESTANE; LETROZOLE; TAMOXIFEN;

ADJUVANT THERAPY; BREAST CANCER; DISEASE FREE SURVIVAL; EARLY CANCER; HORMONAL THERAPY; HUMAN; PATIENT COMPLIANCE; PRIORITY JOURNAL; REVIEW; TREATMENT DURATION;

AGED; ANTINEOPLASTIC AGENTS, HORMONAL; AROMATASE INHIBITORS; BREAST NEOPLASMS; COMORBIDITY; DISEASE-FREE SURVIVAL; ENDOCRINE SYSTEM; FEMALE; HUMANS; MIDDLE AGED; POSTMENOPAUSE; RECURRENCE; RISK; RISK FACTORS; TREATMENT OUTCOME;

EID: 55749111233     PISSN: 10408746     EISSN: None     Source Type: Journal    
DOI: 10.1097/CCO.0b013e3283136770     Document Type: Review

References (31)

1. Ferlay J, Autier P, Boniol M, et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18:581-592.
2. Berrino F, De Angelis R, Sant M, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007; 8:773-783.
3. Khoshnoud MR, Fomander T, Johansson H, Rutqvist LE Long-term pattern of disease recurrence among patients with early-stage breast cancer according to estrogen receptor status and use of adjuvant tamoxifen. Breast Cancer Res Treat 2008; 107:71-78.
4. Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 1996; 14:2738-2746.
5. Rutqvist LE, Wallgren A. Long-term survival of 458 young breast cancer patients. Cancer 1985; 55:658-665.
6. Group EBCTC. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005, 365:1687-1717.
7. Cufer T. Reducing the risk of late recurrence in hormone-responsive breast cancer. Ann Oncol 2007; 18 (Suppl 8):viii18-viii25. This comprehensive review of extended adjuvant therapy for breast cancer gives additional information on the topic.
8. Fisher B, Dignam J, Bryant J, Wolmark N. Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial. J Natl Cancer Inst 2001; 93:684-690.
9. Stewart HJ, Prescott RJ, Forrest AP. Scottish adjuvant tamoxifen trial: a randomized study updated to 15 years. J Natl Cancer Inst 2001; 93:456-462.
10. Tormey DC, Gray R, Falkson HC. Postchemotherapy adjuvant tamoxifen therapy beyond five years in patients with lymph node-positive breast cancer. Eastern Cooperative Oncology Group. J Natl Cancer Inst 1996; 88:1828-1833.
11. Peto R, Davies C, and the ATLAS investigators. ATLAS (Adjuvant Tamoxifen, Longer Against Shorter): international randomized trial of 10 vs 5 years of adjuvant tamoxifen among 11500 women: preliminary results. In: Program and Abstracts of the 30th Annual San Antonio Breast Cancer Symposium; 13-16 December 2007; San Antonio, Texas; Abstract 48.
12. Gray RG, Rea DW, Handley K, et al., aTTom collaborators. aTTom adjuvant Tamoxifen - To offer more?: randomized trial of 10 versus 5 years of adjuvant tamoxifen among 6,934 women with estrogen receptor-positive (ER+) or ER untested breast cancer - preliminary results [abstract 513]. J Clin Oncol 2008, 26. The first report of the aTTom study adds controversy to the question of the optimal duration of adjuvant tamoxifen.
13. Goss PE, Ingle JN, Martino S, et al. Randomized trial of letrozote following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 2005; 97:1262-1271.
14. Mamounas EP, Jeong JH, Wickerham DL, et al. Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intention-to-treat analysis of the National Surgical Adjuvant Breast And Bowel Project B-33 trial. J Clin Oncol 2008; 26:1965-1971.
15. Jakesz R, Greil R, Gnant M, et al. Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a. J Natl Cancer Inst 2007; 99:1845-1853.
16. Goss PE, Ingle JN, Martino S, et al. A randomized trial of tetrozote in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med 2003; 349:1793-1802.
17. Ingle JN, Tu D, Pater JL, et al. Duration of tetrozote treatment and outcomes in the placebo-controlled NdC CTG MA.17 extended adjuvant therapy trial. Breast Cancer Res Treat 2006; 99:295-300.
18. Goss PE, Ingle JN, Pater JL, et al. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. J Clin Oncol 2008; 26:1948-1955. MA17 was the first trial that showed advantage from extended adjuvant therapy. The decision that the trial needs to be unblended and the crossover to letrozole should be offered to patients on the placebo arm as the DFS in the first interim analysis crossed predefined significance was extensively discussed. Unplanned analysis possible after crossover to letrozole was allowed at premature closure showed that even late extended therapy with aromatase inhibitor is superior to 5 years of tamoxifen only.
19. Goldhirsch A, Wood WC, Gelber RD, et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 2007; 18:1133-1144.
20. Howell A, Cuzick J, Baum M, et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 2005; 365:60-62.
21. Thurlimann B, Keshaviah A, Coates AS, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 2005; 353:2747-2757.
22. Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol 2005; 23:619-629.
23. Ramirez ML, Keane TE, Evans CP. Managing prostate cancer: the role of hormone therapy. Can J Urol 2007; 14 (Suppl 1):10-18.
24. Chapman JA, Meng D, Shepherd L, et al. Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. J Natl Cancer Inst 2008; 100:252-260.
25. This is an interesting report on different causes of death among hormone receptor positive breast cancer patients showing that patients at risk for cardiovascular disease and osteoporosis are mainly dying of other nonbreast cancer-related causes despite the diagnosis of breast cancer.
26. Muss HB, Tu D, Ingle JN, et al. Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol 2008; 26:1956-1964. Although hormone receptor positive breast cancer is predominantly the disease of the elderly, they are underrepresented in clinical trials, with MA17 being no exception. The subgroup analysis of the trial failed to show clear benefit from extended letrozole therapy mainly due to the lack of power.
27. Paik S, Shak S, Tang G, et al. Expression of the 21 genes in the Recurrence Score assay and tamoxifen clinical benefit in the NSABP study B-14 of node negative, estrogen receptor positive breast cancer. J Clin Oncol 2005; 23:510.
28. Goetz MP, Rae JM, Suman VJ, et al. Pharmacogenetics of tamoxifen biotransformation is associated with clinical outcomes of efficacy and hot flashes. J Clin Oncol 2005; 23:9312-9318.
29. Punglia RS, Burstein HJ, Winer EP, Weeks JC. Pharmacogenomic variation of CYP2D6 and the choice of optimal adjuvant endocrine therapy for postmenopausal breast cancer: a modeling analysis. J Natl Cancer Inst 2008; 100:642-648. An interesting model developed to apply the results of pharmacogenetic study on the demonstrated aromatase inhibitor's efficacy in the BIG 1-98 trial showing even advantage of tamoxifen when CYP2D6 polymorphism is taken into account.
30. Grabinski JL, Chisholm G, Smith LS, et al. ER alpha genotypes and breast cancer recurrence [abstract 501]. J Clin Oncol 2008; 26. This abstract is opening new questions about relevance of estrogene receptor polymorphism.
31. Whelan TJ, Goss PE, Ingle JN, et al. Assessment of quality of life in MA.17: a randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. J Clin Oncol 2005; 23:6931-6940.