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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Zusammenfassung: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.
Bibliographie:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
ISSN:1527-7755
1527-7755
DOI:10.1200/JCO.2009.23.1274