Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2006 Jun;132(6):343-55.
doi: 10.1007/s00432-006-0081-0. Epub 2006 Feb 1.

Optimizing the use of aromatase inhibitors in adjuvant therapy for postmenopausal patients with hormone-responsive early breast cancer: current and future prospects

Walter Jonat  1 , Felix Hilpert
Affiliations
Review

Optimizing the use of aromatase inhibitors in adjuvant therapy for postmenopausal patients with hormone-responsive early breast cancer: current and future prospects

Walter Jonat et al. J Cancer Res Clin Oncol. 2006 Jun.

Abstract

Purpose: Five years of tamoxifen treatment after primary surgery has had a significant impact on outcomes for women with early breast cancer, but the third-generation aromatase inhibitors (AIs) are now challenging tamoxifen as the gold standard endocrine adjuvant treatment. Results from two large, phase III, early adjuvant studies have indicated that the AIs letrozole and anastrozole offer greater protection against recurrence than tamoxifen in upfront substitution strategies in the first 5 years after surgery. Similarly, changeover to an AI (exemestane or anastrozole) after 2-3 years of tamoxifen has been shown to offer greater protection against recurrence than 5 years of tamoxifen. More than 50% of early breast cancer recurrences occur five or more years after surgery. Letrozole has been shown to offer greater protection against recurrence than placebo in the 5 years after a standard course of tamoxifen. The safety implications of treatment with these potent AIs for 5 years or more are being closely monitored. Anticipated effects of estrogen deprivation on bone health may be treatable with bisphosphonates, and this strategy is under investigation. Effects on the cardiovascular system, and other estrogen-sensitive systems such as the central nervous system, are currently unclear and further results are awaited.

Conclusion: Current evidence indicates that the third-generation AIs will improve outcomes for many women with early breast cancer.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
AI adjuvant treatment strategies under investigation in clinical trials. In all trials, the comparator was the standard therapy for the relevant treatment period. * TEAM trial protocol altered to effect a switch to exemestane after 2–3 years of tamoxifen. † Randomization occurred immediately after surgery in the ABCSG-8 trial but at any time within 2 years of surgery in ARNO 95 (Jakesz et al. 2005a)
See this image and copyright information in PMC

References

    1. ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists’ Group (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359:2131–2139. Erratum in: Lancet (2002) 360:1520 - PubMed
    1. Atalay G, Dirix L, Biganzoli L, Beex L, Nooij M, Cameron D, Lohrisch C, Cufer T, Lobelle JP, Mattiaci MR, Piccart M, Paridaens R (2004) The effect of exemestane on serum lipid profile in postmenopausal women with metastatic breast cancer: a companion study to EORTC Trial 10951, ‘Randomized phase II study in first line hormonal treatment for metastatic breast cancer with exemestane or tamoxifen in postmenopausal patients’. Ann Oncol 15:211–277 - DOI - PubMed
    1. Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Howell A, Sahmoud T, The ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists’ Group (2003) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses. Cancer 98:1802–1810 - PubMed
    1. Bhatnagar AS, Brodie AM, Long BJ, Evans DB, Miller WR (2001) Intracellular aromatase and its relevance to the pharmacological efficacy of aromatase inhibitors. J Steroid Biochem Mol Biol 76:199–202 - DOI - PubMed
    1. Boccardo F, Rubagotti A, Puntoni M, Guglielmini P, Amoroso D, Fini A, Paladini G, Mesiti M, Romeo D, Rinaldini M, Scali S, Porpiglia M, Benedetto C, Restuccia N, Buzzi F, Franchi R, Massidda B, Distante V, Amadori D, Sismondi P (2005) Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the Italian tamoxifen anastrozole trial. J Clin Oncol 23:5138–5147 - DOI - PubMed

MeSH terms

Substances