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March 10, 2008 NEW YORK (Reuters Health) - Treatment with the aromatase inhibitor letrozole improves disease-free survival, even when several years have passed since completing 5 years of tamoxifen for treatment of early breast cancer. These findings stem from an open-label extension of an international phase III trial examining the efficacy of letrozole 2.5 mg/day initiated within 3 months of completing 5 years of adjuvant tamoxifen in postmenopausal patients with hormone receptor-positive tumors. The current analysis, reported online on March 10 by the Journal of Clinical Oncology, includes the 2383 women in the placebo arm of the trial who were still alive and disease free at the time of unblinding in 2003. A total of 1579 patients switched to letrozole (median time since end of tamoxifen treatment 2.8 years, range, 1.1 to 7.1 years). During median follow-up of 2.8 years from unblinding, disease recurrence was observed in 31 patients (2.0%) in the women who chose letrozole and in 39 patients who discontinued all treatment (4.9%). After adjustment for demographic and disease characteristics, letrozole was associated with a 63% reduction in disease recurrence for patients electing to cross over to letrozole from placebo, a 61% reduction in the risk of developing metastases and an 82% reduction in contralateral breast cancer. Overall survival was also better in the letrozole group, Dr. Paul E. Goss, at Massachusetts General Hospital Cancer Center in Boston, and his associates note, but this may be related to women with more comorbidities being less likely to choose letrozole treatment. Although women taking letrozole were at greater risk of developing osteoporosis and clinical fractures, the authors note that the subjects were note receiving prophylactic treatment, which could have prevented these complications. "It appears that most cancers remain estrogen-dependent for long periods in follow-up," the authors concludes, "and that their clinical courses can be improved by the judicious use of aromatase inhibitors, even very late in follow-up." Copyright 2008 Reuters. Click for Restrictions.
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