Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen

To conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2). Data submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyse...

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Veröffentlicht in:	Journal of clinical oncology Jg. 28; H. 3; S. 509
Hauptverfasser:	Dowsett, Mitch, Cuzick, Jack, Ingle, Jim, Coates, Alan, Forbes, John, Bliss, Judith, Buyse, Marc, Baum, Michael, Buzdar, Aman, Colleoni, Marco, Coombes, Charles, Snowdon, Claire, Gnant, Michael, Jakesz, Raimund, Kaufmann, Manfred, Boccardo, Francesco, Godwin, Jon, Davies, Christina, Peto, Richard
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 20.01.2010
Schlagworte:	Aged Antineoplastic Agents - therapeutic use Aromatase Inhibitors - therapeutic use Breast Neoplasms - drug therapy Breast Neoplasms - surgery Chemotherapy, Adjuvant Female Follow-Up Studies Humans Middle Aged Randomized Controlled Trials as Topic Tamoxifen - therapeutic use
ISSN:	1527-7755, 1527-7755
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Abstract	To conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2). Data submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyses of two cohorts. Primary analyses involve postmenopausal women with tumors reported to be estrogen receptor positive. Log-rank P values are two-sided. Cohort 1 comprised 9,856 patients with a mean of 5.8 years of follow-up. At 5 years, AI therapy was associated with an absolute 2.9% (SE = 0.7%) decrease in recurrence (9.6% for AI v 12.6% for tamoxifen; 2P < .00001) and a nonsignificant absolute 1.1% (SE = 0.5%) decrease in breast cancer mortality (4.8% for AI v 5.9% for tamoxifen; 2P = .1). Cohort 2 comprised 9,015 patients with a mean of 3.9 years of follow-up. At 3 years from treatment divergence (ie, approximately 5 years after starting hormonal treatment), AI therapy was associated with an absolute 3.1% (SE = 0.6%) decrease in recurrence (5.0% for AI v 8.1% for tamoxifen since divergence; 2P < .00001) and an absolute 0.7% (SE = 0.3%) decrease in breast cancer mortality (1.7% for AI v 2.4% for tamoxifen since divergence; 2P = .02). There was no convincing heterogeneity in the proportional recurrence reduction with respect to age, nodal status, tumor grade, or progesterone receptor status and no indication of an increase in nonbreast deaths with AIs in either cohort. CONCLUSION AIs produce significantly lower recurrence rates compared with tamoxifen, either as initial monotherapy or after 2 to 3 years of tamoxifen. Additional follow-up will provide clearer information on long-term survival.
AbstractList	To conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2). Data submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyses of two cohorts. Primary analyses involve postmenopausal women with tumors reported to be estrogen receptor positive. Log-rank P values are two-sided. Cohort 1 comprised 9,856 patients with a mean of 5.8 years of follow-up. At 5 years, AI therapy was associated with an absolute 2.9% (SE = 0.7%) decrease in recurrence (9.6% for AI v 12.6% for tamoxifen; 2P < .00001) and a nonsignificant absolute 1.1% (SE = 0.5%) decrease in breast cancer mortality (4.8% for AI v 5.9% for tamoxifen; 2P = .1). Cohort 2 comprised 9,015 patients with a mean of 3.9 years of follow-up. At 3 years from treatment divergence (ie, approximately 5 years after starting hormonal treatment), AI therapy was associated with an absolute 3.1% (SE = 0.6%) decrease in recurrence (5.0% for AI v 8.1% for tamoxifen since divergence; 2P < .00001) and an absolute 0.7% (SE = 0.3%) decrease in breast cancer mortality (1.7% for AI v 2.4% for tamoxifen since divergence; 2P = .02). There was no convincing heterogeneity in the proportional recurrence reduction with respect to age, nodal status, tumor grade, or progesterone receptor status and no indication of an increase in nonbreast deaths with AIs in either cohort. CONCLUSION AIs produce significantly lower recurrence rates compared with tamoxifen, either as initial monotherapy or after 2 to 3 years of tamoxifen. Additional follow-up will provide clearer information on long-term survival. To conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2).PURPOSETo conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3 years of tamoxifen (cohort 2).Data submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyses of two cohorts. Primary analyses involve postmenopausal women with tumors reported to be estrogen receptor positive. Log-rank P values are two-sided.MATERIALS AND METHODSData submitted to the Early Breast Cancer Trialists' Collaborative Group were used in separate meta-analyses of two cohorts. Primary analyses involve postmenopausal women with tumors reported to be estrogen receptor positive. Log-rank P values are two-sided.Cohort 1 comprised 9,856 patients with a mean of 5.8 years of follow-up. At 5 years, AI therapy was associated with an absolute 2.9% (SE = 0.7%) decrease in recurrence (9.6% for AI v 12.6% for tamoxifen; 2P < .00001) and a nonsignificant absolute 1.1% (SE = 0.5%) decrease in breast cancer mortality (4.8% for AI v 5.9% for tamoxifen; 2P = .1). Cohort 2 comprised 9,015 patients with a mean of 3.9 years of follow-up. At 3 years from treatment divergence (ie, approximately 5 years after starting hormonal treatment), AI therapy was associated with an absolute 3.1% (SE = 0.6%) decrease in recurrence (5.0% for AI v 8.1% for tamoxifen since divergence; 2P < .00001) and an absolute 0.7% (SE = 0.3%) decrease in breast cancer mortality (1.7% for AI v 2.4% for tamoxifen since divergence; 2P = .02). There was no convincing heterogeneity in the proportional recurrence reduction with respect to age, nodal status, tumor grade, or progesterone receptor status and no indication of an increase in nonbreast deaths with AIs in either cohort. CONCLUSION AIs produce significantly lower recurrence rates compared with tamoxifen, either as initial monotherapy or after 2 to 3 years of tamoxifen. Additional follow-up will provide clearer information on long-term survival.RESULTSCohort 1 comprised 9,856 patients with a mean of 5.8 years of follow-up. At 5 years, AI therapy was associated with an absolute 2.9% (SE = 0.7%) decrease in recurrence (9.6% for AI v 12.6% for tamoxifen; 2P < .00001) and a nonsignificant absolute 1.1% (SE = 0.5%) decrease in breast cancer mortality (4.8% for AI v 5.9% for tamoxifen; 2P = .1). Cohort 2 comprised 9,015 patients with a mean of 3.9 years of follow-up. At 3 years from treatment divergence (ie, approximately 5 years after starting hormonal treatment), AI therapy was associated with an absolute 3.1% (SE = 0.6%) decrease in recurrence (5.0% for AI v 8.1% for tamoxifen since divergence; 2P < .00001) and an absolute 0.7% (SE = 0.3%) decrease in breast cancer mortality (1.7% for AI v 2.4% for tamoxifen since divergence; 2P = .02). There was no convincing heterogeneity in the proportional recurrence reduction with respect to age, nodal status, tumor grade, or progesterone receptor status and no indication of an increase in nonbreast deaths with AIs in either cohort. CONCLUSION AIs produce significantly lower recurrence rates compared with tamoxifen, either as initial monotherapy or after 2 to 3 years of tamoxifen. Additional follow-up will provide clearer information on long-term survival.
Author	Snowdon, Claire Coates, Alan Dowsett, Mitch Cuzick, Jack Forbes, John Buzdar, Aman Coombes, Charles Baum, Michael Buyse, Marc Peto, Richard Bliss, Judith Boccardo, Francesco Davies, Christina Ingle, Jim Gnant, Michael Colleoni, Marco Jakesz, Raimund Kaufmann, Manfred Godwin, Jon
Author_xml	– sequence: 1 givenname: Mitch surname: Dowsett fullname: Dowsett, Mitch email: mitch.dowsett@icr.ac.uk organization: Academic Department of Biochemistry, Royal Marsden Hospital, London, United Kingdom. mitch.dowsett@icr.ac.uk – sequence: 2 givenname: Jack surname: Cuzick fullname: Cuzick, Jack – sequence: 3 givenname: Jim surname: Ingle fullname: Ingle, Jim – sequence: 4 givenname: Alan surname: Coates fullname: Coates, Alan – sequence: 5 givenname: John surname: Forbes fullname: Forbes, John – sequence: 6 givenname: Judith surname: Bliss fullname: Bliss, Judith – sequence: 7 givenname: Marc surname: Buyse fullname: Buyse, Marc – sequence: 8 givenname: Michael surname: Baum fullname: Baum, Michael – sequence: 9 givenname: Aman surname: Buzdar fullname: Buzdar, Aman – sequence: 10 givenname: Marco surname: Colleoni fullname: Colleoni, Marco – sequence: 11 givenname: Charles surname: Coombes fullname: Coombes, Charles – sequence: 12 givenname: Claire surname: Snowdon fullname: Snowdon, Claire – sequence: 13 givenname: Michael surname: Gnant fullname: Gnant, Michael – sequence: 14 givenname: Raimund surname: Jakesz fullname: Jakesz, Raimund – sequence: 15 givenname: Manfred surname: Kaufmann fullname: Kaufmann, Manfred – sequence: 16 givenname: Francesco surname: Boccardo fullname: Boccardo, Francesco – sequence: 17 givenname: Jon surname: Godwin fullname: Godwin, Jon – sequence: 18 givenname: Christina surname: Davies fullname: Davies, Christina – sequence: 19 givenname: Richard surname: Peto fullname: Peto, Richard
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Snippet	To conduct meta-analyses of randomized trials of aromatase inhibitors (AIs) compared with tamoxifen either as initial monotherapy (cohort 1) or after 2 to 3...
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SubjectTerms	Aged Antineoplastic Agents - therapeutic use Aromatase Inhibitors - therapeutic use Breast Neoplasms - drug therapy Breast Neoplasms - surgery Chemotherapy, Adjuvant Female Follow-Up Studies Humans Middle Aged Randomized Controlled Trials as Topic Tamoxifen - therapeutic use
Title	Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen
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