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Special populations: Young breast cancer survivors who have gone through menopause
Hormonal therapy reduces the risk of recurrence for women with early-stage breast cancer that is ER-and/or PR-positive. Standard therapy lasts 5 years. A new study looks at whether extending one type of hormonal therapy, known as aromatase inhibitor therapy, to 10 years lowers recurrence rates even more for these women. (7/26/16)
Whether patients will benefit (lower risk of recurrence or new breast cancer in the other breast) if they stay on aromatase inhibitor therapy for 10 years rather than the standard 5 years.
According to the lead author of this research study, patients with early-stage breast cancer live for a long time, but “face an indefinite risk of relapse.”
This data suggests that extending aromatase inhibitor therapy to 10 years instead of stopping it at 5 may improve patient outcomes. Women who were on aromatase inhibitor therapy for 10 years did not have recurrences or develop new cancers in the other breast, although the difference between the 5-year and 10-year groups was relatively low. Women should have a risk/benefit conversation with their healthcare providers to discuss if extending aromatase inhibitor therapy is right for them. Patients also need to consider the side effects of aromatase inhibitors and the cost of the drug.
Clinical Oncology News
Researchers of this current study explored whether extending the length of time women took the aromatase inhibitor provided additional benefit. Paul Goss and his colleagues at Massachusetts General Hospital and other institutions presented their data on this new clinical trial (MA.17R) at the 2016 American Society of Clinical Oncology Meeting, Their observations of what happens when women take an aromatase inhibitor for 10 years instead of 5 were also published in The New England Journal of Medicine.
This study follows previous research showing that taking an aromatase inhibitor (Letrozole) after 5 years of tamoxifen improved disease-free survival.
Whether patients who stay on an aromatase inhibitor for 10 years have fewer recurrences and develop fewer new breast cancers than patients who take aromatase inhibitors for 5 years.
The study enrolled 1,918 postmenopausal women who had estrogen receptor (ER)- and/or progesterone receptor (PR)-positive, early-stage breast cancer.
Women in the study fell into 1 of 3 groups:
Among the 3 groups of women, some were randomized to receive another 5 years of AI therapy (Letrozole) or 5 years of receiving a placebo.
This research did not take genetic status into account, so how women with mutations in BRCA or other genes that increase cancer risk respond to an additional 5 years of aromatase inhibitor therapy is unknown. Some patients involved in the study had previously taken tamoxifen, while some had not. From the data presented, it is not known if the use of tamoxifen before an aromotase inhibitor affected a patient’s risk of recurrence or new cancer. Finally, a number of aromatase inhibitors are available, and not all women in the study took the same aromatase inhibitor for the first 5 years.
The results of this study suggest that taking an aromatase inhibitor for 10 years instead of 5 may benefit ER- and/or PR-positive breast cancer patients. But there was no increase in overall survival between women who took aromatase inhibitors for 5 years and those who took aromatase inhibitors for 10 years. Patients should discuss with their health care provider all the risks and benefits when thinking about extending their aromatase inhibitor for longer than 5 years.
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Goss PE, Ingle JN, Pritchard K, et al, “Extending adjuvant Letrozole for 5 years after completing an initial 5 years of Aromatase Inhibitor therapy alone or preceded by Tamoxifen in Postmenopausal Women with Early-Stage Breast Cancer: A Randomized Phase III Open Label Trial.” Presented by Paul Goss at the 2016 American Society of Clinical Oncology Meeting.
Goss PE, Ingle JN, Pritchard K, et al, “Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years.” The New England Journal of Medicine. Published online first on June 5th, 2016.
Goss, Pe. “Letrozole in the extended adjuvant setting: MA.17.” Breast Cancer Research and Treatment. 2007;105:45-53.
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