Switching to Anastrozole Versus Continued Tamoxifen Treatment of Early Breast Cancer: Preliminary Results of the Italian Tamoxifen Anastrozole Trial

Boccardo, Francesco; Rubagotti, Alessandra; Puntoni, Matteo; Guglielmini, Pamela; Amoroso, Domenico; A, Fini; Paladini, Giuseppe; Mesiti, M.; Romeo, D; Rinaldini, M.; Scali, Simona; Porpiglia, M; Benedetto, Chiara; Restuccia, N.; Buzzi, Franco; Franchi, Roberto; Massidda, B.; Distante, V.; Amadori, Dino; Sismondi, P

doi:10.1200/jco.2005.04.120

Cited by 448 publications

(314 citation statements)

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“…[2][3][4] Although tamoxifen has been the cornerstone of treatment for hormone-sensitive early breast cancer, recently reported randomized clinical trials (RCTs) clearly indicate the benefit of AI. [5][6][7][8][9][10][11][12][13][14][15] These benefits, despite strategic differences across RCTs and patient populations, are consistent with all AIs, and previously reported cumulative analyses have indicated that there is an overall survival benefit to the already documented advantage in diseasefree survival (DFS). 7,14 Despite these positive aspects, toxicity profile and the pharmacoeconomic aspects should always be taken into account when discussing new treatment strategies, particularly in the presence of small benefits.…”

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confidence: 59%

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Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer

Cuppone

Bria

Verma

et al. 2007

Cancer

116

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BACKGROUND.Despite the advantages from using aromatase inhibitors (AIs) compared with tamoxifen for early breast cancer, an unexpectedly greater number of grade 3 and 4 cardiovascular events (CVAE) (as defined by National Cancer Institute of Canada‐Common Toxicity Criteria [version 2.0] was demonstrated.METHODS.Phase 3 randomized clinical trials (RCTs) comparing AI with tamoxifen in early breast cancer were considered eligible for this review. The event‐based risk ratios (RRs) with 95% confidence intervals (95% CIs) were derived, and a test of heterogeneity was applied. Finally, absolute differences (ADs) in event rates and the number of patients needed to harm 1 patient (NNH) were determined.RESULTS.Seven eligible RCTs (19,818 patients) reported CVAE results. When considering all RCTs, the AD of the primary endpoint (CVAE) between the 2 arms (0.52%), tamoxifen versus AI, was statistically significant (RR, 1.31; 95% CI, 1.07–1.60; P = .007). This translated into an NNH value of 189 patients; when only third‐generation AIs were considered, the difference (0.57%) remained significant (RR, 1.34; 95% CI, 1.09–1.63; P = .0038). Thromboembolic events were significantly more frequent in the tamoxifen arm, regardless of the strategy adopted (RR, 0.53; 95% CI, 0.42–0.65; P < .0001), without significant heterogeneity (P = .21). An AD of 1.17% and an NNH value of 85 patients were observed.CONCLUSIONS.According to the results from this meta‐analysis, the risk of grade 3 and 4 CVAEs in patients who were receiving AIs was higher compared with the risk in patients who were receiving tamoxifen, and the difference reached statistical significance. However, the AD was relatively low, and from 160 to 180 patients had to be treated to produce 1 event. Cancer 2008. © 2007 American Cancer Society.

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confidence: 59%

“…Seven trials (19,818 patients) were identified that were eligible for inclusion in this analysis 5,6,8,[10][11][12][13]15,25 ( Fig. 1).…”

Section: Selected Trialsmentioning

confidence: 99%

Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer

Cuppone

Bria

Verma

et al. 2007

Cancer

116

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“…Ovarian ablation, as an adjuvant therapy, has been demonstrated to lead to longer survival in premenopausal patients [4]. Aromatase inhibitors have also shown efficacy in reducing the risk for recurrence and/or death in postmenopausal patients with hormone-responsive early breast cancers [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The CYP19 TTTA Repeat Polymorphism Is Related to the Prognosis of Premenopausal Stage I–II and Operable Stage III Breast Cancers

et al. 2008

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After completing this course, the reader should be able to:1. Describe why premenopausal women with the long allele of the CYP19 TTTA repeat polymorphism have a greater survival rate and may not gain benefit from adjuvant chemotherapy.2. Assess whether we need to revisit the routine use of adjuvant chemotherapy in high-risk premenopausal patients with the long allele of the CYP19 polymorphism.3. Explain why further validation in a randomized study with a large sample size is needed to determine whether the CYP19 TTTA repeat polymorphism can serve as a predictor in hormone receptor-positive premenopausal patients.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTPurpose. Given the critical role of the CYP19 gene, encoding aromatase, in estrogen synthesis and the association of the estrogen level with its TTTA repeat polymorphism, the potential influence of this polymorphism on breast cancer survival, and hence management, deserves further study.

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“…For many years, tamoxifen was the cornerstone of endocrine therapy with a substantial body of evidence showing benefits in overall survival [1]. However, more recently, trials of AIs have shown benefits over tamoxifen, in both a metastatic [2][3][4] and subsequent adjuvant treatment setting [5][6][7][8][9][10][11]. The main advantages have been improvements in disease free survival and a more favourable toxicity profile, with lower rates of thromboembolic phenomena and endometrial malignancy.…”

Section: Introductionmentioning

confidence: 99%

Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more?

Din

Dodwell

Wakefield

et al. 2010

Breast Cancer Res Treat

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Aromatase inhibitors (AIs) are a standard of care for the adjuvant treatment of hormone responsive early carcinoma of the breast as demonstrated in a number of large international phase III randomised trials. Arthralgia was a somewhat unexpected side effect of this class of agents and has proven to be potentially problematic in clinical practice. Although rates of up 35% have been reported in the randomised trials, the figure has been much higher in subsequent case series. There is concern that these symptoms are significant and may affect compliance and thus the overall efficacy of treatment. It is therefore extremely important that we evaluate this syndrome with a view to gaining more information regarding its clinical features and possible aetiological mechanism. The potential aetiological mechanisms and evidence for aromatase inhibitor-induced arthralgia (AIA) are reviewed in this article. Looking forward, it is now important that prospective clinical trials are well designed to evaluate this syndrome and potential therapeutic strategies to circumvent it. Radiological imaging and biochemical analyses may help our understanding of AIA and these are discussed.

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Switching to Anastrozole Versus Continued Tamoxifen Treatment of Early Breast Cancer: Preliminary Results of the Italian Tamoxifen Anastrozole Trial

Abstract: Switching to anastrozole after the first 2 to 3 years of treatment is well tolerated and significantly improves event-free and recurrence-free survival in postmenopausal patients with early breast cancer.

Cited by 448 publications

References 29 publications

Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer

Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer

The CYP19 TTTA Repeat Polymorphism Is Related to the Prognosis of Premenopausal Stage I–II and Operable Stage III Breast Cancers

Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more?

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