2.50
Hdl Handle:
http://hdl.handle.net/10541/76595
Title:
Are aromatase inhibitors superior to antiestrogens?
Authors:
Howell, Anthony ( 0000-0002-3879-5991 ) ; Buzdar, Aman
Abstract:
Aromatase inhibitors (AIs) have been in use to treat metastatic breast cancer for over 25 years. Recently potent and specific AIs have been introduced, which, because of their low toxicity profile, are being used in the adjuvant and neoadjuvant situation and also for the prevention of breast cancer. The two non-steroidal AIs, anastrozole and letrozole, and the steroidal AI, exemestane, have all shown superiority to tamoxifen as first-line treatment for advanced breast cancer. Interestingly, the oestrogen receptor downregulator, fulvestrant, was shown to be equivalent to anastrozole when compared as second-line therapy after the failure of tamoxifen. The first adjuvant AI trial began in 1996 and recruited over 9000 patients (ATAC trial). Anastrozole was compared with tamoxifen and a combination of the two drugs. There were no significant differences between tamoxifen and the combination. However, anastrozole showed about a 20% improvement in disease-free survival in ER+ disease compared with the other treatments. An overall survival analysis will be reported later this year. Two trials have compared 5 years of tamoxifen with 2-3 years of tamoxifen, followed by 2-3 years of AI (one trial (ITA) used anastrozole and another (intergroup) exemestane). Both trials show a disease-free advantage for the switch to AI. In another study (MA17) 5 years of tamoxifen was followed by a randomisation to letrozole or placebo and showed a significant disease-free advantage to the AI. Both letrozole and anastrozole show superiority to tamoxifen when used as a neoadjuvant therapy. Anastrozole significantly reduced contralateral breast cancer compared with tamoxifen, and this has led to two prevention trials: one in women at risk comparing anastrozole with placebo and the other after excision of DCIS comparing anastrozole with tamoxifen (IBIS II). The NCI Canada has also just initiated a trial of exemestane for prevention. Nearly all data available indicate that AIs are superior to tamoxifen. The important question is whether survival is improved when they are used as adjuvant therapy?
Affiliation:
CRUK Department of Medical Oncology, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK. anthony.howell@christie-tr.nwest.nhs.uk
Citation:
Are aromatase inhibitors superior to antiestrogens? 2005, 93 (2-5):237-47 J. Steroid Biochem. Mol. Biol.
Journal:
The Journal of Steroid Biochemistry and Molecular Biology
Issue Date:
Feb-2005
URI:
http://hdl.handle.net/10541/76595
DOI:
10.1016/j.jsbmb.2005.02.004
PubMed ID:
15860266
Type:
Article
Language:
en
ISSN:
0960-0760
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorHowell, Anthony-
dc.contributor.authorBuzdar, Aman-
dc.date.accessioned2009-08-06T15:20:15Z-
dc.date.available2009-08-06T15:20:15Z-
dc.date.issued2005-02-
dc.identifier.citationAre aromatase inhibitors superior to antiestrogens? 2005, 93 (2-5):237-47 J. Steroid Biochem. Mol. Biol.en
dc.identifier.issn0960-0760-
dc.identifier.pmid15860266-
dc.identifier.doi10.1016/j.jsbmb.2005.02.004-
dc.identifier.urihttp://hdl.handle.net/10541/76595-
dc.description.abstractAromatase inhibitors (AIs) have been in use to treat metastatic breast cancer for over 25 years. Recently potent and specific AIs have been introduced, which, because of their low toxicity profile, are being used in the adjuvant and neoadjuvant situation and also for the prevention of breast cancer. The two non-steroidal AIs, anastrozole and letrozole, and the steroidal AI, exemestane, have all shown superiority to tamoxifen as first-line treatment for advanced breast cancer. Interestingly, the oestrogen receptor downregulator, fulvestrant, was shown to be equivalent to anastrozole when compared as second-line therapy after the failure of tamoxifen. The first adjuvant AI trial began in 1996 and recruited over 9000 patients (ATAC trial). Anastrozole was compared with tamoxifen and a combination of the two drugs. There were no significant differences between tamoxifen and the combination. However, anastrozole showed about a 20% improvement in disease-free survival in ER+ disease compared with the other treatments. An overall survival analysis will be reported later this year. Two trials have compared 5 years of tamoxifen with 2-3 years of tamoxifen, followed by 2-3 years of AI (one trial (ITA) used anastrozole and another (intergroup) exemestane). Both trials show a disease-free advantage for the switch to AI. In another study (MA17) 5 years of tamoxifen was followed by a randomisation to letrozole or placebo and showed a significant disease-free advantage to the AI. Both letrozole and anastrozole show superiority to tamoxifen when used as a neoadjuvant therapy. Anastrozole significantly reduced contralateral breast cancer compared with tamoxifen, and this has led to two prevention trials: one in women at risk comparing anastrozole with placebo and the other after excision of DCIS comparing anastrozole with tamoxifen (IBIS II). The NCI Canada has also just initiated a trial of exemestane for prevention. Nearly all data available indicate that AIs are superior to tamoxifen. The important question is whether survival is improved when they are used as adjuvant therapy?en
dc.language.isoenen
dc.subjectOestrogen Receptor Modulatorsen
dc.subjectBreast Canceren
dc.subjectCanceren
dc.subject.meshAromatase Inhibitors-
dc.subject.meshBreast Neoplasms-
dc.subject.meshChemotherapy, Adjuvant-
dc.subject.meshClinical Trials as Topic-
dc.subject.meshDrug Tolerance-
dc.subject.meshEstrogen Receptor Modulators-
dc.subject.meshHumans-
dc.subject.meshNeoadjuvant Therapy-
dc.subject.meshNeoplasms, Hormone-Dependent-
dc.subject.meshReceptors, Estrogen-
dc.subject.meshSafety-
dc.subject.meshTamoxifen-
dc.titleAre aromatase inhibitors superior to antiestrogens?en
dc.typeArticleen
dc.contributor.departmentCRUK Department of Medical Oncology, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK. anthony.howell@christie-tr.nwest.nhs.uken
dc.identifier.journalThe Journal of Steroid Biochemistry and Molecular Biologyen
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