Journal
BREAST
Volume 19, Issue 2, Pages 76-83Publisher
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.breast.2009.12.010
Keywords
Adjuvant hormonal therapy; Tamoxifen; Aromatase inhibitor; Breast cancer
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Funding
- Jean Shanks Foundation Intercalated Grant
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Adjuvant tamoxifen reduces relapses and prolongs survival in patients with oestrogen sensitive breast cancer. Development of resistance is however common. Tamoxifen can be given for a maximum of five years; although the risk of recurrences remains high after this period. This review examines nine randomised controlled trials including 28 632 women, which studied aromatase inhibitors (AIs) as an alternative to tamoxifen in three treatment settings: monotherapy (instead of tamoxifen), sequenced therapy (tamoxifen is switched to an AI) and extended therapy (following adjuvant tamoxifen). Disease free survival was significantly improved for monotherapy (HR 0.89, [95% CI 0.83-0.96] p = 0.002) and sequenced therapy (HR 0.72, [0.63-0.83] p < 0.00001). There was no difference in overall survival for monotherapy (HR 0.94, [0.82-1.08] p = 0.39) or extended therapy (HR 0.86 [0.79-116] p = 0.67). Importantly, overall survival was prolonged for patients who switched from tamoxifen to AI therapy (HR 0.78 95%CI 0.68-0.91, p = 0.001). (C) 2009 Elsevier Ltd. All rights reserved.
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