Clinical and Economic Benefits of Aromatase Inhibitor Therapy in Early-stage Breast Cancer

Stefan Glück; Fariborz Gorouhi

Disclosures

Am J Health Syst Pharm. 2011;68(18):1699-1706. 

In This Article

Summary

Currently available therapeutic agents have significantly prolonged survival for a subset of patients with early-stage breast cancer. However, for patients whose disease recurs, the risk of death is considerable, particularly for patients with distant recurrence. In addition to being the most deadly type of recurrence, distant metastasis is also the most costly. Thus, therapies that reduce the risk of distant metastasis may improve not only long-term survival but also the cost-effectiveness of medical intervention. Emerging data have demonstrated potential overall survival advantages for AIs subsequent and directly related to distant recurrence. Of the nonsteroidal AIs, letrozole appears to have the efficacy advantage by demonstrating an early effect on distant recurrence and, subsequently, a potentially significant overall survival benefit, though results of a prospective head-to-head trial of anastrozole and letrozole are not yet available.

When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence. However, preliminary analyses indicate that the survival benefit appears to be greater with letrozole than with anastrozole. Thus, considering potential survival benefits and cost-effectiveness, it appears that letrozole may be preferable to anastrozole in the early adjuvant setting. Long-term results from the head-to-head FACE trial will likely provide definitive information on the efficacy differences between letrozole and anastrozole as well as long-term cost data.

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