Switching from tamoxifen to aromatase inhibitors for adjuvant endocrine therapy in postmenopausal patients with early breast cancer

Velde, C.J.H. van de; Verma, Sunil; Nes, Johanna G. H. van; Masterman, C.; Pritchard, Kathleen I.

doi:10.1016/j.ctrv.2009.10.003

Cited by 16 publications

(13 citation statements)

References 43 publications

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“…Increasing the permissible gap from ER estrogen receptor, PR progesterone receptor a Not able to define number of drug classes used in the year after cohort entry as patients were not registered for 1 year or more in the PHARMO RLS after cohort entry 123 60 to 180 days indicates that around 15% of the patients restart treatment during 5 years of follow-up. To date, multiple clinical trials have demonstrated that 5 year use of adjuvant endocrine treatment among patients with hormone receptor positive, early stage breast cancer improves disease free and overall survival [1,19,20]. However, high discontinuation rates as reported in this observational study, lower the benefit found in clinical trials.…”

Section: Discussioncontrasting

confidence: 51%

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

Herk‐Sukel

Poll‐Franse

Voogd

et al. 2010

Breast Cancer Res Treat

123

100

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Section: Discussioncontrasting

confidence: 51%

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

Herk‐Sukel

Poll‐Franse

Voogd

et al. 2010

Breast Cancer Res Treat

123

100

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“…Adjuvant endocrine therapy, which is an integral component in the treatment of patients with ER + and/or PR + breast cancer, exerts its effect by reducing the availability of estrogen to micrometastatic tumour cells (Goss et al , 2003; BIG 1-98 Collaborative Group, 2009; van de Velde et al , 2010). Thus TAM, the most commonly used hormonal treatment for breast cancer patients, was introduced into clinical practice in the 1970s and has substantially improved survival duration in patients with hormone receptor-positive breast cancers (Jaiyesimi et al , 1995; O'Regan and Jordan, 2002; Breast International Group (BIG) 1-98 Collaborative Group et al , 2005; Clarke, 2008; Rose, 2008; Masuda et al , 2012).…”

Section: Discussionmentioning

confidence: 99%

Combined effects of goserelin and tamoxifen on estradiol level, breast density, and endometrial thickness in premenopausal and perimenopausal women with early-stage hormone receptor-positive breast cancer: a randomised controlled clinical trial

Yang

Zong

et al. 2013

Br J Cancer

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Background:This study is to investigate the effects of geserelin+tamoxifen (TAM) on estradiol level, breast density (BD), endometrial thickness (ET), and blood lipids in premenopausal and perimenopausal women with hormone receptor-positive early-stage breast cancer.Methods:This study recruited 110 premenopausal and perimenopausal patients with hormone receptor-positive early-stage breast cancer between 22 June 2008 and 31 December 2009 and randomly assigned them to receive either goserelin plus TAM or TAM alone for 1.5 years. Blood levels of sex hormones and lipids and ET were determined at 0, 3, 6, 12, and 18 months. Contralateral BD was also measured at 0, 12, and 18 months.Results:Five participants dropped out of the goserelin plus TAM group, and two participants dropped out of the TAM-alone group before initiation of endocrine therapy. The rest of patients received scheduled treatment and 3 years of median follow-up. No serious adverse effects were observed, and only two local recurrences have been observed in these patients. Estradiol level and BD were lower in the goserelin plus TAM group than in the TAM-alone group (P<0.05). The endometrium in the goserelin plus TAM group was significantly thinner than that in the TAM-alone group (P<0.05), and women in the TAM-alone group exhibited endometrial thickening over the course of the study. Furthermore, no significant differences in blood lipid levels were reported between the two groups.Conclusion:The data from the current study demonstrated that the addition of goserelin to TAM results in downregulation of estradiol level, followed by significant reduction in BD and ET in premenopausal and perimenopausal women with hormone receptor-positive breast cancer, which may eventually lead to better outcome in these patients.

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“…The decision of whether to switch to an AI after 2–3 years of tamoxifen depends on a careful evaluation of the individual patient’s situation in addition to the efficiency data provided by the literature. On the one hand, quality of life and the particular adverse event profiles of tamoxifen and the AIs must be weighed [7,8,9,19,20]. However, sometimes, psychological aspects can play an important role.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical trials have assessed patients receiving treatment with tamoxifen for 2–3 years, followed by an AI for 2–3 years, to complete a total of 5 years of endocrine therapy [2,4,5,6]. This switch strategy was associated with significant improvement in disease-free and overall survival when compared with continuing tamoxifen treatment alone [7,8,9], and some authors conclude that sequenced therapy appears to be the preferred treatment regime [8]. …”

Section: Introductionmentioning

confidence: 99%

Eligibility, Compliance and Persistence of Sequential Therapy with Aromatase Inhibitors following 2–3 Years of Tamoxifen in Endocrine Adjuvant Breast Cancer Therapy

Kilic

Myrick²,

Schmid³

et al. 2011

Oncology

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Objective: This study evaluated the eligibility, compliance and persistence of sequential therapy, i.e. a switch to an aromatase inhibitor (AI) following 2–3 years of tamoxifen, in adjuvant endocrine breast cancer (BC) treatment. Methods: Data concerning 388 BC patients (age ≤70 years) who started endocrine adjuvant therapy between 1998 and 2008 were analyzed. Results: From the 263 patients who started therapy with tamoxifen, 167 (63.5%) were eligible for a sequential therapy. Fifty-nine patients (35.3%) were offered a switch by their physicians; women who had their follow-up at oncological units received the offer more often when compared to those treated by general practitioners (p < 0.001). Out of these 59 patients, 50 followed the proposal (compliance 84.7%). Of those who agreed to a sequential therapy, 2 (4%) were non-persistent to endocrine therapy; in 9 cases (18.0%), a re-switch to tamoxifen was done due to AI-related adverse side effects. Conclusions: Only a minority of the patients who started an endocrine adjuvant BC therapy was eligible for sequential therapy. Patients who underwent a switch had a high rate of persistence. Efforts should be made to make sure that all physicians, above all general practitioners, who are involved in the treatment of BC patients, are provided with current therapy guidelines.

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Switching from tamoxifen to aromatase inhibitors for adjuvant endocrine therapy in postmenopausal patients with early breast cancer

Cited by 16 publications

References 43 publications

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

Combined effects of goserelin and tamoxifen on estradiol level, breast density, and endometrial thickness in premenopausal and perimenopausal women with early-stage hormone receptor-positive breast cancer: a randomised controlled clinical trial

Eligibility, Compliance and Persistence of Sequential Therapy with Aromatase Inhibitors following 2–3 Years of Tamoxifen in Endocrine Adjuvant Breast Cancer Therapy

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