Benefit With Aromatase Inhibitors in the Adjuvant Setting for Postmenopausal Women With Breast Cancer

Henning T. Mouridsen, MD, PhD; Nicholas J. Robert, MD

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In This Article

Conclusions

For more than 20 years, a 5-year course of adjuvant tamoxifen has been the standard endocrine treatment for women with hormone receptor-positive breast cancer. However, this standard is being challenged by recent clinical trial results demonstrating either the superior efficacy of aromatase inhibitors vs tamoxifen as early adjuvant therapy of early breast cancer in postmenopausal women, or increased benefits when sequenced after tamoxifen for 2 to 3 years or 5 years. There is a trend toward replacing tamoxifen with 5 years of aromatase inhibitor in the early adjuvant setting for postmenopausal women. For the estimated 500,000 women worldwide who currently receive adjuvant tamoxifen, switching to an aromatase inhibitor should be considered -- either to exemestane or anastrozole after 2 to 3 years of tamoxifen therapy, or starting letrozole following completion of 5 years of tamoxifen.

Data on long-term efficacy and safety in ongoing trials will address important issues concerning the optimal use of tamoxifen and aromatase inhibitors in the adjuvant setting: single drug or sequential; duration of treatment; and criteria for individual patient selection to maximize treatment benefits. As more results from ongoing adjuvant trials become available, additional changes in treatment approaches are likely to be implemented, advances that will further improve outcomes in women with hormone receptor - positive early breast cancer.

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