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Women with the type of breast cancer normally treated with tamoxifen would be better off taking a class of drugs called aromatase inhibitors, according to authors of a study published online by The Lancet.
Tamoxifen therapy for five years after surgery is the established treatment for postmenopausal women with hormone-sensitive breast cancer. However, its use is associated with several side effects including endometrial cancer and blood-clotting disorders.
Now, five-year follow-up results from the ATAC study, an international collaboration which compared the safety and efficacy of tamoxifen with anastrozole alone and the combination of both drugs, has shown anastrozole to be clearly superior.
The results showed that anastrozole, compared with tamoxifen: increased disease-free survival by over 10 percent; increased the time to disease recurrence by around 20 percent; reduced cancer spreading (distant metastases) by 14 percent, and reduced cancer occurring on the other breast by over 40 percent.
Fewer women given anastrozole stopped taking the tablets early compared with women given tamoxifen; anastrozole was associated with fewer side effects although bone fractures and joint pain were more common than among women given tamoxifen.
"Results from studies evaluating aromatase inhibitors after 2–3 years or 5 years of adjuvant tamoxifen, compared with continuing tamoxifen, suggest that it is reasonable to switch patients currently on tamoxifen to an aromatase inhibitor," said leading researcher Dr. Anthony Howell of Manchester.
"However, these new data from the ATAC trial suggest that it is not appropriate to wait to start an aromatase inhibitor," Howell said.
"Five years of anastrozole should now be considered as the preferred initial adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer," he said.
Source: Medical Week staff, week of December 8, 2004
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