Tamoxifen and Anastrozole As a Sequencing Strategy: A Randomized Controlled Trial in Postmenopausal Patients With Endocrine-Responsive Early Breast Cancer From the Austrian Breast and Colorectal Cancer Study Group

Dubsky, Peter; Jakesz, R.; Mlineritsch, Brigitte; Pöstlberger, Sabine; Samonigg, Hellmut; Kwasny, Werner; Tausch, Christoph; Stöger, Herbert; Haider, Karin; Fitzal, Florian; Singer, Christian F.; Stierer, M.; Sevelda, P.; Luschin-Ebengreuth, G.; Taucher, Susanne; Rudas, Margaretha; Bartsch, Rupert; Steger, G.; Greil, Richard; Filipcic, Lidija; Gnant, Michael

doi:10.1200/jco.2011.36.8993

Cited by 93 publications

(64 citation statements)

References 24 publications

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“…Patients included in ABCSG-8 did not receive neoadjuvant or adjuvant chemotherapy, nor did any patient receive trastuzumab. The sequence strategy of 2 years of tamoxifen followed by 3 years of anastrozole led to moderate outcome benefits (20,21).…”

Section: Patientsmentioning

confidence: 99%

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The PAM50 Risk-of-Recurrence Score Predicts Risk for Late Distant Recurrence after Endocrine Therapy in Postmenopausal Women with Endocrine-Responsive Early Breast Cancer

Filipits¹,

Nielsen

Rudas

et al. 2014

Clinical Cancer Research

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187

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Purpose: To assess the prognostic value of the PAM50 risk-of-recurrence (ROR) score on late distant recurrence (beyond 5 years after diagnosis and treatment) in a large cohort of postmenopausal, endocrineresponsive breast cancer patients.Experimental Design: The PAM50 assay was performed on formalin-fixed paraffin-embedded wholetumor sections of patients who had been enrolled in the Austrian Breast and Colorectal Cancer Study Group Trial 8 (ABCSG-8). RNA expression levels of the PAM50 genes were determined centrally using the nCounter Dx Analysis System. Late distant recurrence-free survival (DRFS) was analyzed using Cox models adjusted for clinical and pathologic parameters.Results: PAM50 analysis was successfully performed in 1,246 ABCSG-8 patients. PAM50 ROR score and ROR-based risk groups provided significant additional prognostic information with respect to late DRFS compared with a combined score of clinical factors alone (ROR score: DLRc 2 15.32, P < 0.001; ROR-based risk groups: DLRc 2 14.83, P < 0.001). Between years 5 and 15, we observed an absolute risk of distant recurrence of 2.4% in the low ROR-based risk group, as compared with 17.5% in the high ROR-based risk group. The DRFS differences according to the PAM50 ROR score were observed for both node-positive and node-negative disease. Conclusion: PAM50 ROR score and ROR-based risk groups can differentiate patients with breast cancer with respect to their risk for late distant recurrence beyond what can be achieved with established clinicopathologic risk factors. Clin Cancer Res; 20(5); 1298-305. Ó2014 AACR.

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Section: Patientsmentioning

confidence: 99%

“…The study design, inclusion criteria, and the main results of ABCSG-8 have been reported elsewhere (20,21). Between 1996 and 2004, 3,901 postmenopausal women with hormone receptor-positive early-stage breast cancer were randomized to receive either 5 years of adjuvant tamoxifen or tamoxifen for 2 years followed by anastrozole for 3 years.…”

Section: Patientsmentioning

confidence: 99%

The PAM50 Risk-of-Recurrence Score Predicts Risk for Late Distant Recurrence after Endocrine Therapy in Postmenopausal Women with Endocrine-Responsive Early Breast Cancer

Filipits¹,

Nielsen

Rudas

et al. 2014

Clinical Cancer Research

Self Cite

187

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“…This may reflect the fact that AIs do not display the well-known protective effect of tamoxifen, although no evidence is present of any increase as compared with placebo (Jakesz et al 2005, Kaufmann et al 2007, Forbes et al 2008, Bliss et al 2012, Dubsky et al 2012, Boccardo et al 2013.…”

Section: Cardiovascular Adverse Eventsmentioning

confidence: 94%

Aromatase inhibitors in the breast cancer clinic: focus on exemestane

Asten¹,

Neven²,

Lintermans³

et al. 2014

Endocrine-Related Cancer

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Breast cancer is the most prevalent type of cancer in women and responsible for significant female cancer-related mortality worldwide. In the Western world, over 80% of breast cancers are hormone-receptor positive for which endocrine therapy is administered. The main anti-estrogen treatments in use consist of selective estrogen-receptor modulators, such as tamoxifen, and third-generation aromatase inhibitors (AIs), such as exemestane, letrozole, and anastrozole. In this review, the focus will lie on exemestane, its clinical use, and its side-effect profile. Exemestane is the only third-generation steroidal AI. Its efficacy as a first-line treatment in metastatic breast cancer has been demonstrated. Therefore, exemestane could be considered a valid first-line therapeutic option, but it also can be used in second-line or further situations. Exemestane is mostly used as part of sequential adjuvant treatment following tamoxifen, but in this setting it is also active in monotherapy. Furthermore, this AI has been studied in the neoadjuvant setting as presurgical treatment, and even as chemoprevention in high-risk healthy postmenopausal women. It may reverse side effects of tamoxifen, such as endometrial changes and thromboembolic disease but may also cause some inconvenient side effects itself. Additionally, there is a lack of total crossresistance between exemestane and nonsteroidal AIs as far as their anti-tumoral efficacy is concerned; moreover the two classes of AIs display a nontotal overlapping toxicity profile. Taking together, exemestane can be considered as a useful treatment option at all stages of breast cancer.

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“…When endocrine therapies were used in combination, the overall incidence of all-grade alopecia was 10.5% (95% CI: 7.1%-15.4%) (heterogeneity test: Q ϭ 25.036, I2 ϭ 76.035, p Ͻ .001) [17,18,22,24,26,30,44]. There was a significant difference between combination and single-agent therapies in alopecia (RR: 2.92; 95% CI: 2.56 -3.38; p ϭ .002), supporting an additive or synergistic effect in the development of alopecia when agents are combined.…”

Section: Increased Risk For Alopecia With Combination Of Endocrine Thmentioning

confidence: 99%

Alopecia With Endocrine Therapies in Patients With Cancer

Saggar

Dickler

et al. 2013

The Oncologist

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Tamoxifen and Anastrozole As a Sequencing Strategy: A Randomized Controlled Trial in Postmenopausal Patients With Endocrine-Responsive Early Breast Cancer From the Austrian Breast and Colorectal Cancer Study Group

Abstract: Despite a low overall rate of recurrence in a population with breast cancer at limited risk of relapse, the a priori sequence strategy of 2 years of TAM followed by 3 years of ANA led to small outcome and toxicity benefits.

Cited by 93 publications

References 24 publications

The PAM50 Risk-of-Recurrence Score Predicts Risk for Late Distant Recurrence after Endocrine Therapy in Postmenopausal Women with Endocrine-Responsive Early Breast Cancer

The PAM50 Risk-of-Recurrence Score Predicts Risk for Late Distant Recurrence after Endocrine Therapy in Postmenopausal Women with Endocrine-Responsive Early Breast Cancer

Aromatase inhibitors in the breast cancer clinic: focus on exemestane

Alopecia With Endocrine Therapies in Patients With Cancer

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