Abstract
Adjuvant hormonal therapy for postmenopausal women with early stage breast cancer has become far more complex over the past several years. This commentary reviews the current status of the five major trials evaluating the use of the aromatase inhibitors in the adjuvant setting. The data currently available suggest that the aromatase inhibitors are efficacious either as upfront therapy or after a course of tamoxifen. Ongoing trials will compare these approaches and guide the use of these agents in the years to come.
Highlights
Adjuvant hormonal therapy for postmenopausal women with hormone receptor positive breast cancer has become far more complex over the past several years
Five major randomized trials have contributed to our understanding of the role of the aromatase inhibitors in the adjuvant setting
At a median of 68 months of follow up, the Anastrozole or Tamoxifen Alone or in Combination (ATAC) trial demonstrated a hazard ratio (HR) of 0.83 (95% confidence interval [CI] 0.73–0.94) for women with hormone receptor positive breast cancer treated with anastrozole [2]
Summary
Adjuvant hormonal therapy for postmenopausal women with hormone receptor positive breast cancer has become far more complex over the past several years. The standard of care for postmenopausal women with early stage, estrogen receptor positive breast cancer was treatment for 5 years with tamoxifen, which reduced the annual risk for disease recurrence by almost 50% [1]. The Anastrozole or Tamoxifen Alone or in Combination (ATAC) trial and the International Breast Cancer Study Group’s BIG 1-98 trial compared an aromatase inhibitor (letrozole) versus tamoxifen as initial hormonal therapy in the adjuvant setting [2,3,4].
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