Breast Cancer 2013: 2 TAM Trials Top List

Shira Berman

Disclosures

December 23, 2013

In This Article

Breast Cancer 2013: How Far Did We Come?

What did we learn about managing breast cancer in 2013? Medscape asked Lidia Schapira, MD, from the Massachusetts General Hospital in Boston, Massachusetts, and Kathy Miller, MD, from the Indiana University School of Medicine in Indianapolis, Indiana, for some insight.

If we look strictly at clinical trial data, results from ATLAS[1] and aTTom[2] clearly top the list, they said. These studies confirmed that 10 years of adjuvant tamoxifen therapy in patients with hormone-receptor-positive breast cancer is better than 5 years of therapy -- a finding that clearly changes standard oncology practice.

But survival numbers are only part of the equation. The effects of treatment and disease on quality of life are increasingly playing an important role in breast cancer care, and shifts in funding for and conducting of research studies are changing the way in which clinical trials inform clinical practice.

What does all of this mean for oncologists who treat patients with breast cancer?

Adjuvant Therapy: The Long and the Short of It

The ability to define the optimal duration of adjuvant endocrine therapy for patients with estrogen-receptor (ER) and progesterone-receptor (PR) positive disease has been a somewhat elusive goal for many years. Finally, in 2013, long-term data from the international ATLAS[1] and the United Kingdom-based aTTom[2] studies clearly demonstrated that 10 years of tamoxifen therapy is better than 5 years of therapy in reducing the risk for recurrence and overall deaths.

"This provides an important treatment option for young women who remain premenopausal after completing 5 years of tamoxifen," Dr. Schapira said. "It also lends support to the concept that longer duration of therapy is beneficial for all women with ER-positive or PR-positive breast cancer."

The fact that these benefits were not apparent until more than a decade had passed since diagnosis is also significant from a clinical practice standpoint, noted Dr. Schapira. "This finding reminds us of the importance of long term treatment and follow-up for our patients."

But longer is not necessarily better when it comes to the duration of adjuvant radiation therapy, Dr. Schapira reminded us. Upon examining 10-year data from the START trials,[3] researchers found that a hypofractionated regimen using higher doses over 3 weeks is as good as lower doses over 5 weeks, which had been the standard in many countries.

In some populations, even the shorter regimen of adjuvant radiation therapy may not be necessary. Long-term follow-up CALGB 9343[4] showed that adjuvant radiation therapy added to tamoxifen yields a small reduction in recurrence but not a survival advantage over tamoxifen alone among patients older than 70 years who have small, ER/PR-positive, clinically node-negative cancers. This, noted Dr. Schapira, is a good example of one of the many "important advances in recognizing that older patients may fare very well with less treatment."

The common element behind all of these studies, of course, is the appreciation for the need to strike a very careful balance between treatment effectiveness and treatment side effects. Long-term data from well-designed clinical trials such as these are critical to optimizing outcomes for patients with early breast cancer.

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