Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen Journal Article


Authors: Goss, P. E.; Ingle, J. N.; Pater, J. L.; Martino, S.; Robert, N. J.; Muss, H. B.; Piccart, M. J.; Castiglione, M.; Shepherd, L. E.; Pritchard, K. I.; Livingston, R. B.; Davidson, N. E.; Norton, L.; Perez, E. A.; Abrams, J. S.; Cameron, D. A.; Palmer, M. J.; Tu, D. S.
Article Title: Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen
Abstract: Purpose The National Cancer Institute of Canada Clinical Trials Group MA. 17 trial examined the efficacy of letrozole (LET) started within 3 months of 5 years of adjuvant tamoxifen in postmenopausal hormone receptor-positive early-stage breast cancer. When the trial was unblinded, patients who received placebo (PLAC) were offered LET. Patients and Methods This cohort analysis describes the outcomes of women assigned PLAC at the initial random assignment after unblinding. Efficacy outcomes of women who chose LET (PLAC-LET group) were compared with those who did not (PLAC-PLAC group) by the hazard ratios and by P values calculated from Cox models that adjusted for imbalances between the groups. Toxicity analyses included only events that occurred after unblinding. Results There were 1,579 women in the PLAC-LET group (median time from tamoxifen, 2.8 years) and 804 in the PLAC-PLAC group. Patients in the PLAC-LET group were younger; had a better performance status; and were more likely to have had node-positive disease, axillary dissection, and adjuvant chemotherapy than those in the PLAC-PLAC group. At a median follow-up of 5.3 years, disease-free survival (DFS; adjusted hazard ratio [ HR], 0.37; 95% CI, 0.23 to 0.61; P <.0001) and distant DFS (HR, 0.39; 95% CI, 0.20 to 0.74; P =.004) were superior in the PLAC-LET group. More self-reported new diagnoses of osteoporosis and significantly more clinical fractures occurred in the women who took LET (5.2% v 3.1%, P =.02). Conclusion Interpretation of this cohort analysis suggests that LET improves DFS and distant DFS even when there has been a substantial period of time since the discontinuation of prior adjuvant tamoxifen.
Keywords: survival; estrogen; therapy; aromatase; inhibitors; randomized-trial; postmenopausal women; american-society; oncology-technology-assessment; updated findings
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 12
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-04-01
Start Page: 1948
End Page: 1955
Language: English
ACCESSION: WOS:000255054700010
DOI: 10.1200/jco.2007.11.6798
PROVIDER: wos
PUBMED: 18332475
Notes: --- - Article - "Source: Wos"
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  1. Larry Norton
    692 Norton