A global perspective on the use of aromatase inhibitors in early-stage breast cancer.

Abstract

Abstract Abstract #1144 Background: Aromatase inhibitors (AIs) are considered to be the standard of care for the adjuvant treatment of postmenopausal patients with hormone-receptor positive (HR+) early breast cancer (EBC). However, there is a lack of data on the use of these drugs in the non-trial setting and in regional practice around the world.
 Methods: This survey examined the use of endocrine therapies in breast cancer by physicians in 7 countries. From July 27 to October 8, 2007, 462 physicians in the United States, Germany, the United Kingdom, France, Spain, Italy, and Japan were surveyed, and information was collected via an internet Web site. Data included the physicians' reported activity during the last month, AI profiles, and patient profiles according to treatment stage.
 Results: Surveyed were 381 oncologists, 14 gynecologists, 36 surgeons, and 31 mammary gland clinicians. Physician perceptions were similar to the actual patient data. Half of all women being treated for breast cancer were HR+ and postmenopausal (less in Japan: 38%), and almost all of those patients (80-95%) were receiving endocrine therapy for the adjuvant treatment of EBC. AIs were the most common hormone agents used in the initial adjuvant setting of postmenopausal women with HR+ EBC across all countries surveyed (55-93%; median 88%). An upfront AI strategy was the most common practice overall, particularly in Japan, the United States, and France (89%, 86%, and 86%, respectively). Initial tamoxifen therapy was used predominantly in Germany (36%), the United Kingdom (51%), and Italy (55%). However, in the United Kingdom and Germany, the intent in nearly half of these patients was to switch to an AI following 2 years of tamoxifen therapy. The rates at which the 3 AIs were prescribed for different types of adjuvant treatment were generally consistent across countries. Guidelines were identified as a major decision-making factor in all countries.
 Conclusion: There are variations in practice across the surveyed countries despite the presence of international guidelines, eg, the American Society of Clinical Oncology and St. Gallen 2007. These practice trends may reflect the various guidelines in each region. Differences in treatment are particularly seen in Europe, which may reflect the number of varying guidelines and less descriptive nature of the guidelines. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1144.