Aromatase inhibitors should be first-line treatment for certain type of breast cancer

December 08, 2004

Women with the type of breast cancer normally treated with tamoxifen could instead benefit from a class of drugs called aromatase inhibitors, conclude authors of a fast-track study published online by THE LANCET.

Tamoxifen therapy for five years after surgery is the established treatment for postmenopausal women with hormone-sensitive breast cancer. However, its use is associated with several side effects including endometrial cancer and blood-clotting disorders. The ATAC study is an international collaboration which compared the safety and efficacy of tamoxifen with anastrozole alone and the combination of both drugs for 5 years. The 3-year analysis of these data were encouraging, suggesting that anastrozole could be a future treatment option (see Lancet 2002; 359: 2131-39).

Published today are the 5-year follow-up results of the ATAC study. They show how anastrozole, compared with tamoxifen: increased disease-free survival by over 10%; increased the time to disease recurrence by around 20%; reduced cancer spreading (distant metastases) by 14%, and reduced cancer occurring on the other breast by over 40%.

Fewer women given anastrozole stopped taking the tablets early compared with women given tamoxifen; anastrozole was associated with fewer side effects although bone fractures and joint pain were more common than among women given tamoxifen.

Lead investigator Anthony Howell (Christie Hospital NHS Trust, Manchester, UK) comments: "Results from studies evaluating aromatase inhibitors after 2-3 years or 5 years of adjuvant tamoxifen, compared with continuing tamoxifen, suggest that it is reasonable to switch patients currently on tamoxifen to an aromatase inhibitor. However, these new data from the ATAC trial suggest that it is not appropriate to wait to start an aromatase inhibitor. The higher rates of recurrence (especially in years 1-3), and the increased numbers of adverse events and treatment withdrawals associated with tamoxifen, lend support to the approach of offering the most effective and well tolerated therapy at the earliest opportunity. 5 years of anastrozole should now be considered as the preferred initial adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer."
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  • The findings are being published early online at www.thelancet.com to coincide with the presentation of the study at the San Antonio Breast Cancer Symposium taking place in Texas, USA, this week.

    Contact: Professor Anthony Howell (mobile phone 44-779-883-6802; please note that Prof Howell is in San Antonio which is 6 hours behind GMT). Alternative contact: Joan Houghton, 44-771-805-360 who is also in San Antonio.

    Lancet

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