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A Review of the Efficacy of Anastrozole in Postmenopausal Women with Advanced Breast Cancer with Visceral Metastases

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Abstract

Tumors that have spread to the liver or lungs (visceral metastases) are associated with a worse prognosis than tumors in soft tissue and bone only. Here we review available efficacy data to address whether or not anastrozole, a non-steroidal aromatase inhibitor (AI), is effective in postmenopausal patients with advanced breast cancer (ABC) and visceral metastases. We include data from Phase III clinical trials, comparing clinical benefit (CB) with anastrozole versus tamoxifen as a first-line treatment, and versus megestrol acetate (MA) or fulvestrant as a second-line therapy. Patients in these trials had adequate organ function and the volume of disease had to be minimal or moderate for them to be eligible for inclusion. First-line treatment of patients with or without visceral metastases in the overall population resulted in CB rates of 49.5 and 62.3%, respectively, for anastrozole and 46.9 and 55.9%, respectively, for tamoxifen. In patients with confirmed hormone receptor (HR)-positive tumors, the CB rate was 51.9 and 65.7%, respectively, for anastrozole and 41.6 and 58.7%, respectively, for tamoxifen. In patients with or without visceral metastases, second-line treatment with anastrozole resulted in a CB rate of 31.4 and 51.8%, respectively, compared with 31.9 and 47.1%, respectively, for those treated with MA. Patients in the overall population with and without visceral metastases treated with anastrozole obtained a CB rate of 37.4 and 43.8%, respectively, while those treated with fulvestrant obtained a CB rate of 38.2 and 47.6%, respectively. In patients with confirmed HR-positive tumors, CB was seen in 37.6 and 41.5%, respectively, of patients treated with anastrozole and in 37.3 and 47.0%, respectively, of patients treated with fulvestrant. The results reveal anastrozole to be an effective and valuable first- and second-line therapy in postmenopausal women with ABC and visceral metastases, showing similar CB to other endocrine therapies.

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References

  1. Diab SG, Elledge RM, Clark GM: Tumour characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92: 550-556, 2000

    Google Scholar 

  2. Cole MP, Jones CT, Todd ID: A new estrogenic agent in late breast cancer. An early clinical appraisal of ICI46474. Br J Cancer 25: 270-275, 1971

    Google Scholar 

  3. Miller WR, Stuart M, Sahmoud Y, Dixon JM: Anastrozole ('Arimidex') blocks oestrogen synthesis both peripherally and within the breast in postmenopausal women with large operable breast cancer. Br J Cancer 87: 950-955, 2002

    Google Scholar 

  4. Masamura S, Adlercreutz H, Harvey H: Aromatase inhibitor development for the treatment of breast cancer. Breast Cancer Treat 33: 19-26, 1994

    Google Scholar 

  5. Buzdar A, Jonat W, Howell A, Jones SE, Blomqvist C, Vogel CL, EiermannW, Wolter JM, AzabM, Webster A, Plourde PV: Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal women with advanced breast cancer: results of overview analysis of two phase III trials. J Clin Oncol 14: 2000-2011, 1996

    Google Scholar 

  6. Bonneterre J, Thurlimann B, Robertson JF, Krzakowski M, Mauriac L, Koralewski P, Vergote I, Webster A, Steinberg M, von Euler M: Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women-results of the TARGET (Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability) study. J Clin Oncol 18: 3748-3757, 2000

    Google Scholar 

  7. Nabholtz JM, Buzdar A, Pollak M, Harwin W, Burton G, Mangalik A, Steinberg M, Webster A, von Euler M: Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. J Clin Oncol 18: 3758-3767, 2000

    Google Scholar 

  8. Bonneterre J, Buzdar A, Nabholtz JM, Robertson JF, Thurlimann B, von Euler M, Sahmoud T, Webster A, Steinberg M, Arimidex Writing Committee, Investigators Committee Members: Anastrozole is superior to tamoxifen as firstline therapy in hormone receptor positive advanced breast carcinoma: results of two randomized trials designed for combined analysis. Cancer 92: 2247-2258, 2001

    Google Scholar 

  9. Nabholtz JM, Bonneterre J, Budzar A, Robertson JFR, Thürlimann B: Anastrozole (ArimidexTM) versus tamoxifen as first-line therapy in hormone-receptor positive advanced breast cancer in postmenopausal women: survival results of two randomized trials designed for combined analysis. Eur J Cancer (submitted)

  10. Ellis MJ, Hayes DF, Lippman ME: Diseases of the Breast. 2nd edn, Lippincott Williams &; Wilkins, Philadelphia, 2000, pp 749-797

    Google Scholar 

  11. Vergote I, Thürlimann B: First-line endocrine therapy in postmenopausal patients with advanced breast cancer and visceral metastases: anastrozole versus tamoxifen. Eur J Cancer 37(Suppl 6): 191, abstract 697, 2001

    Google Scholar 

  12. Thürlimann B, Bonneterre J, Budzar A, Nabholtz J-M, Robertson J, Sahmoud T: First-line endocrine therapy in postmenopausal patients with advanced breast cancer and visceral metastases: anastrozole (Arimidex) versus tamoxifen. Proc Am Soc Clin Oncol 20: 1835, 2001 (abstract)

    Google Scholar 

  13. Mouridsen H, Gershanovich M, Sun Y, Perez-Carrion R, Boni C, Monnier A, Apffelstaedt J, Smith R, Sleeboom HP, Janicke F, Pluzanska A, Dank M, Becquart D, Bapsy PP, Salminen E, Snyder R, Lassus M, Verbeek JA, Staffler B, Chaudri-Ross HA, Dugan M: Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a Phase III study of the International letrozole breast cancer group. J Clin Oncol 19: 2596-2606, 2001

    Google Scholar 

  14. Blanco G, Holli K, Heikkinen M, Kallioniemi OP, Taskinen P: Prognostic factors in recurrent breast cancer: relationships to site of recurrence, disease-free interval, female sex steroid receptors, ploidy and histological malignancy grading. Br J Cancer 62: 142-146, 1990

    Google Scholar 

  15. Clark GM, Sledge Jr GW, Osborne CK, McGuire WL: Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol 5: 55-61, 1987

    Google Scholar 

  16. Qazi R, Chuang JL, Drobyski W: Estrogen receptors and the pattern of relapse in breast cancer. Arch Int Med 144: 2365-2367, 1984

    Google Scholar 

  17. Singhakowinta A, Potter HG, Buroker TR, Samal B, Brooks SC, Vaitkevicius VK: Estrogen receptor and natural course of breast cancer. Ann Surg 183: 84-88, 1976

    Google Scholar 

  18. Osborne CK, Pippen J, Jones SE, Parker LM, Ellis M, Come S, Gertler SZ, May JT, Burton G, Dimery I, Webster A, Morris C, Elledge R, Buzdar A: Double-blind randomized trial comparing the efficacy and tolerability of fulvestrant versus anastrozole in post-menopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial. J Clin Oncol 20: 3386-3395, 2002

    Google Scholar 

  19. Howell A, Robertson JF, Quaresma Albano J, Aschermannova A, Mauriac L, Kleeberg UR, Vergote I, Erikstein B, Webster A, Morris C: Fulvestrant, formerly ICI 182,780 is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20: 3396-3403, 2002

    Google Scholar 

  20. Jonat W, Howell A, Blomqvist C, Eiermann W, Winblad G, Tyrrell C, Mauriac L, Roche H, Lundgren S, Hellmund R, Azab M: A randomised trial comparing two doses of the new selective aromatase inhibitor anastrozole (Arimidex) with megestrol acetate in postmenopausal patients with advanced breast cancer. Eur J Cancer 32A: 404-412, 1996

    Google Scholar 

  21. Howell A, Buzdar A, Jonat W: Arimidex (anastrozole)-effective in advanced breast cancer (ABC) patients with visceral and liver metastases. Breast Cancer Res Treat 50 Special Issue 304: 434, 1998 (abstract)

    Google Scholar 

  22. Mauriac L, Pippen JE, Quaresma Albano J, Gertler SZ, Kent Osbourne C: Fulvestrant (Faslodex®) versus anastrozole for the treatment of advanced breast cancer in a subgroup of postmenopausal women with visceral metastases: combined results from two multicentre trials. Eur J Cancer 39: 1228-1233, 2003

    Google Scholar 

  23. Data on file: AstraZeneca, Macclesfield, Cheshire, UK, 2002

  24. Kamby C, Rose C: Metastatic pattern and response to endocrine therapy in human breast cancer. Breast Cancer Res Treat 8: 197-204, 1986

    Google Scholar 

  25. Perez JE, Machiavelli M, Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Rodriguez R, Cuevas MA, Alvarez LA: Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Am J Clin Oncol (CCT) 13: 294-298, 1990

    Google Scholar 

  26. Falkson G, Gelman R, Falkson CI, Glick J, Harris J: Factors predicting for response, time to treatment failure and survival in women with metastatic breast cancer treated with DAVTH: a prospective Eastern Cooperative Oncology Group Study. J Clin Oncol 9: 2153-2161, 1991

    Google Scholar 

  27. Rabinovich M, Vallejo C, Bianco A, Perez J, Machiavelli M, Leone B, Romero A, Rodriguez R, Cuevas M, Dansky C: Development and validation of prognostic models in metastatic breast cancer: a GOCS study. Oncology 49: 188-195, 1992

    Google Scholar 

  28. Dombernowsky P, Smith I, Falkson G, Leonard R, Panasci L, Bellmunt J, Bezwoda W, Gardin G, Gudgeon A, Morgan M, Fornasiero A, Hoffmann W, Michel J, Hatschek T, Tjabbes T, Chaudri HA, Hornberger U, Trunet PF: Letrozole, a new oral aromatase inhibitor for advanced breast cancer: double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate. J Clin Oncol 16: 453-461, 1998

    Google Scholar 

  29. Kaufmann M, Bajetta E, Dirix LY, Fein LE, Jones SE, Zilembo N, Dugardyn JL, Nasurdi C, Mennel RG, Cervek J, Fowst C, Polli A, di Salle E, Arkhipov A, Piscitelli G, Miller LL, Massimini G: Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a Phase III randomized double-blind trial. J Clin Oncol 18: 1399-1411, 2000

    Google Scholar 

  30. Jones S, Vogel C, Arkhipov A, Fehrenbacher L, Eisenberg P, Cooper B, Honig S, Polli A, Whaley F, di Salle E, Tiffany J, Consonni A, Miller L: Multicenter, Phase II trial of exemestane as third-line hormonal therapy of postmenopausal women with metastatic breast cancer. Aromasin Study Group. J Clin Oncol 17: 3418-3425, 1999

    Google Scholar 

  31. Kvinnsland S, Anker G, Dirix LY, Bonneterre J, Prove AM, Wilking N, Lobelle JP, Mariani O, di Salle E, Polli A, Massimini G: High activity and tolerability demonstrated for exemestane in postmenopausal women with advanced breast cancer failing tamoxifen. Eur J Cancer 36: 976-982, 2000

    Google Scholar 

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Authors and Affiliations

  1. Cancer Research UK Department of Medical Oncology, Christie CRC Research Hospital, Christie Hospital National Health Service Trust, University of Manchester, Manchester, UK

    A. Howell

  2. Professorial Unit of Surgery, City Hospital, Nottingham, UK

    J.F.R. Robertson

  3. Department of Gynaecological Oncology, University Hospital Leuven, Belgium

    I. Vergote

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  1. A. Howell
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  2. J.F.R. Robertson
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  3. I. Vergote
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Howell, A., Robertson, J. & Vergote, I. A Review of the Efficacy of Anastrozole in Postmenopausal Women with Advanced Breast Cancer with Visceral Metastases. Breast Cancer Res Treat 82, 215–222 (2003). https://doi.org/10.1023/B:BREA.0000004375.17920.0b

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  • DOI: https://doi.org/10.1023/B:BREA.0000004375.17920.0b

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