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Two strategies for breast cancer recurrence may be equal
Source: (cancerfacts.com)
Wednesday, December 23, 2009
Fourth of four summaries of studies presented at the San Antonio Breast Cancer conference Dec. 9-13
SAN ANTONIO – Dec. 23, 2009 – It apparently doesn't matter whether women treated for early stage breast cancer take a combination of hormone treatments for five years afterwards, or whether they take a single newer treatment, new data show.
The two different strategies to prevent breast cancer recurrence compared postmenopausal women treated first with tamoxifen for 2.5 years and then switch to exemestane (Aromasin®) to similar women treated with exemestane alone.
Researchers presented the late breaking five-year data from the TEAM (Tamoxifen Exemestane Adjuvant Multinational) trial at the San Antonio Breast Cancer Symposium, held Dec. 9-13. Tamoxifen has been the standard treatment to prevent breast cancer recurrence for more than a decade. Newer drugs, called aromatase inhibitors, also have been shown to be effective. Consequently, much research is underway to determine how and whether the two drugs ought to be used.
"This is the only aromatase inhibitor study that has used exemestane as initial endocrine therapy compared to tamoxifen followed by exemestane (Aromasin®)," said study author Dr. Daniel Rea, senior lecturer in medical oncology at the University of Birmingham, United Kingdom. "This is also the only study with sufficient power to reliably determine if an aromatase inhibitor as initial therapy is superior to a sequential approach starting with tamoxifen."
In the TEAM trial, researchers randomly assigned 9,775 postmenopausal women with hormone receptor-positive early breast cancer to exemestane daily, or tamoxifen daily after initial treatment. All women had undergone surgery for invasive breast cancer. All tumors were hormone receptor positive, 50 percent were node negative, meaning no cancer in the lymph nodes, and 36 percent had received chemotherapy. The trial began in 2001, and in 2004 the researchers reassigned all women who were initially receiving tamoxifen to switch to exemestane after 2.5 to three years.
The trial's two primary endpoints were disease-free survival for tamoxifen vs. exemestane at 2.75 years and disease-free survival at five years for women initially receiving exemestane vs. those who switched from tamoxifen to exemestane. The results of the first part of the trial were presented at a previous conference.
At this year's symposium the results of the second part of the study showed no significant difference between women who started and stayed with exemestane for five years compared those who started with tamoxifen and switched to exemestane.
Based on the result, the researchers will now analyze subgroups of patients to potentially identify those women that might benefit from different treatment approaches.
"In addition to analysis by traditional prognostic features, we may be able to identify subgroups defined by relatively simple biomarkers which can be used or combined with standard prognostic variables to rationally select optimal treatment strategies," Rea said.
SOURCE: adapted from press materials provided by the American Association for Cancer Research
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