Skip to main content
SpringerLink
Log in

Update on adjuvant hormonal treatment of early breast cancer

  • Part 1
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better disease-free survival, particularly in the worst-prognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–1717.

    Article  Google Scholar 

  2. Coates AS, Keshaviah A, Thurlimann B, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol. 2007;25:486–492.

    Article  PubMed  CAS  Google Scholar 

  3. Coombes RC, Kilburn LS, Snowdon CF, et al. Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet. 2007;369:559–570.

    Article  PubMed  CAS  Google Scholar 

  4. Howell A, Cuzick J, Baum M, et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet. 2005;365:60–62.

    Article  PubMed  CAS  Google Scholar 

  5. Baum M, Budzar AU, Cuzick J, et al. 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. 2002;359:2131–2139.

    Article  PubMed  CAS  Google Scholar 

  6. Baum M, Buzdar A, Cuzick J, et al. 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. 2003;98:1802–1810.

    Article  PubMed  CAS  Google Scholar 

  7. Forbes JF, Cuzick J, Buzdar A, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9:45–53.

    Article  PubMed  Google Scholar 

  8. Cuzick J, Sestak I, Baum M, et al. Effect of anastrozole and tamoxifen as adjuvante treatment for early-stage breast cancer: 10 years analysis of the ATAC trial. Lancet. 2010;11:1135–1141.

    Article  CAS  Google Scholar 

  9. BIG 1-98 Collaborative Group, Mouridsen H, Giobbie-Hurder A, et al. Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med. 2009;361:766–776.

    Article  PubMed  CAS  Google Scholar 

  10. Breast International Group (BIG) 1-98 Collaborative Group, Thürlimann B, Keshaviah A, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J med. 2005;353:2747–2757.

    Article  PubMed  Google Scholar 

  11. van de Velde CJ, Rea D, Seynaeve C, et al. Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomized phase 3 trial. Lancet. 2011;377:321–331.

    Article  PubMed  Google Scholar 

  12. Seynaeve C, Velde van de CJH, Maartense E, et al. Tamoxifen and exemestane adjuvant multinational (TEAM) trial; findings from the Dutch/Belgian subset. Eur J Cancer. 2009;7(Suppl): Abstract P–5136.

    Google Scholar 

  13. Rea D, Hasenburg A, Seynaeve C, et al. Five years of exemestane as initial therapy compared to 5 years of tamoxifen followed by exemestane: The TEAM trial, a prospective, randomized, phase III trial in postmenopausal women with hormone-sensitive early breast cancer. Cancer Res. 2009;69(Suppl 3): Abstract II.

    Google Scholar 

  14. Coombes RC, Hall E, Gibson LJ, et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med. 2004;350:1081–1092.

    Article  PubMed  CAS  Google Scholar 

  15. Coombes RC. Survival and safety post study treatment completion: an updated analysis of the Intergroup Exemestane Study (IES). 15th Congress of the European CanCer Organisation and 34th Congress of the European Society for Medical Oncology. Berlin, Germany. September 20–25, 2009; Abstract 5.011.

  16. Bliss J, Kilburn L, Coleman R, et al. Disease related outcome with long term follow-up: an updated Analysis of the intergroup exemestane study (IES). Cancer Res 2009;69(Suppl 3):Abstract 12.

    Google Scholar 

  17. Dowsett M, Cuzick J, Ingle J, et al. Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol. 2010;28:509–518.

    Article  PubMed  CAS  Google Scholar 

  18. Goss PE, Muss HB, Ingle JN, et al. Extended adjuvant endocrine therapy in breast cancer: current status and future directions. Clin Breast Cancer. 2008;8:411–417.

    Article  PubMed  CAS  Google Scholar 

  19. Goss PE, Ingle JN, Martino S, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med. 2003;349:1793–1802.

    Article  PubMed  CAS  Google Scholar 

  20. Goss PE, Ingle JN, Martino, S et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA. 17. J Natl Cancer Inst. 2005;97:1262–1271.

    Article  PubMed  CAS  Google Scholar 

  21. Goss PE, Ingle JN, Pater JL, et al. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. J Clin Oncol. 2008;26:1948–1955.

    Article  PubMed  CAS  Google Scholar 

  22. Mamounas EP, Jeong JH, Wickerham DL, et al. Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intention-to-treat analysis of the National Surgical Adjuvant Breast And Bowel Project B-33 trial. J Clin Oncol. 2008;26:1965–1971.

    Article  PubMed  CAS  Google Scholar 

  23. Boccardo F, Rubagotti A, Guglielmini P, et al. Switching to anastrozole versus continued tamoxifen treatment of early breast cancer. Updated results of the Italian tamoxifen anastrozole (ITA) trial. Ann Oncol. 2006;17:10–14.

    Google Scholar 

  24. Kaufmann M, Jonat W, Hilfrich J, et al. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. J Clin Oncol. 2007;25:2664–2670.

    Article  PubMed  CAS  Google Scholar 

  25. Jakesz R, Jonat W, Gnant M, et al. Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years’ adjuvant tamoxifen: combined results of ABCSG trial 8 and ARNO 95 trial. Lancet. 2005;366:455–462.

    Article  PubMed  CAS  Google Scholar 

  26. Viale G, Regan M, Dell’Orto P. Central Review of ER, PgR and HER2 in BIG 1-98 Evaluating Letrozole vs. Letrozole Followed by Tamoxifen vs. Tamoxifen Followed by Letrozole as Adjuvant Endocrine Therapy for Postmenopausal Women with Hormone Receptor-Positive Breast Cancer. Cancer Research. 2009;69: Abstract 76.

  27. AECC Contra el Cáncer. Available at: https://www.aecc.es/SobreElCancer/CancerPorLocalizacion/CanverMama/Paginas/incidencia.aspx. Accessed April 5, 2011.

  28. Janni W, Hepp P. Adjuvant aromatase inhibitor therapy: outcomes and safety. Cancer Treat Rev. 2010;36:249–261.

    Article  PubMed  CAS  Google Scholar 

  29. Coleman RE, Banks LM, Girgis SI, et al. Skeletal effects of exemestane on bone-mineral density, bone biomarkers, and fracture incidence in postmenopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES): a randomised controlled study. Lancet Oncol. 2007;8:119–127.

    Article  PubMed  CAS  Google Scholar 

  30. Hadji P, Aapro M, Brufsky A, et al. Practical guidance for the prevention of aromatase inhibitor-associated bone loss in women with breast cancer. Ann Oncol. 2008;19:1407–1416.

    Article  PubMed  CAS  Google Scholar 

  31. Crew KD, Greenle H, Capodice J, et al. Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol. 2007;3877–3883.

  32. Mosca L, Ferris A, Fabunmi R, Robertson RM. Tracking Women’s Awareness of Heart Disease: An American Heart Association National Study. Circulation. 2004;109:573–579.

    Article  PubMed  Google Scholar 

  33. Grundy SM, Cleeman JI, Merz CN, et al; Coordinating Committee on the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Arterioscler Thromb Vasc Biol. 2004;24.e149–161.

    CAS  Google Scholar 

  34. Burstein HJ, Prestrud AA, Seidenfeld J, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28:3784–3796.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oncology Department, Hospital Miguel Servet, Zaragoza, Spain

    Juan Lao Romera & Teresa de Jesús Puertolas Hernández

  2. Oncology Department, Hospital Cabueñes, Gijón, Spain

    Ignacio Peláez Fernández, Teresa Sampedro Gimeno & Roberto Fernández Martínez

  3. Oncology Department, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain

    Isaura Fernández Pérez

  4. Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain

    Vega Iranzo González Cruz

  5. Oncology Department, Hospital de Navarra, Pamplona, Spain

    José Juan Illarramendi Mañas

  6. Oncology Department, Hospital Universitario de La Ribera, Alzira, Spain

    Salvador Garcerá Juan

  7. Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain

    Eva María Ciruelos Gil

Authors
  1. Juan Lao Romera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teresa de Jesús Puertolas Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ignacio Peláez Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa Sampedro Gimeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Fernández Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isaura Fernández Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vega Iranzo González Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. José Juan Illarramendi Mañas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Salvador Garcerá Juan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eva María Ciruelos Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva María Ciruelos Gil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lao Romera, J., Puertolas Hernández, T.d.J., Peláez Fernández, I. et al. Update on adjuvant hormonal treatment of early breast cancer. Adv Therapy 28 (Suppl 6), 1 (2011). https://doi.org/10.1007/s12325-011-0017-1

Download citation

  • Received:

  • Published:

  • DOI: https://doi.org/10.1007/s12325-011-0017-1

Keywords

Search

Navigation