Extended adjuvant endocrine therapy in hormone-receptor-positive early breast cancer

Purpose of review: The risk of relapse associated with oestrogen receptor-positive early breast cancer persists for at least 15 years after diagnosis. Several large clinical trials have examined extended adjuvant endocrine therapy. Recent findings: The MA.17 trial demonstrated improved disease-free survival (DFS) with use of letrozole for 5 years after some years of tamoxifen and an overall survival advantage for this approach in women with node-positive oestrogen receptor-positive cancer at diagnosis. The subsequent adjuvant tamoxifen – to offer more? and adjuvant tamoxifen: longer against shorter trials demonstrated a DFS advantage for 10 years of tamoxifen over 5 years. The recently reported MA.17R trial randomized women who had already completed 5 years of aromatase inhibitor therapy with or without previous tamoxifen to further 5 years of letrozole or placebo. DFS was significantly improved in the extended letrozole group, quality of life was similar but bone fracture rates were higher. The absolute benefit in terms of reduced distant recurrences in these studies is modest, and tolerability and compliance challenges remain. Summary: Physicians and patients now have multiple evidence-based treatment options for women who complete 5 years of adjuvant endocrine therapy. Extended therapy with either tamoxifen or letrozole should be considered for all and decision based on menopausal status, individual risk, tolerance and magnitude of potential benefit.
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: BREAST CANCER: Edited by Giuseppe Curigliano Source Type: research

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Publication date: Available online 11 October 2019Source: The Journal of Steroid Biochemistry and Molecular BiologyAuthor(s): Tang Li, Wenfa Zhang, Sheng-Xiang LinAbstractIn spite of the significant progress of estrogen-dependent breast cancer (BC) treatment, aromatase inhibitor resistance is a major problem limiting the clinical benefit of this frontier endocrine-therapy. The aim of this study was to determine the differential expression of steroid-converting enzymes between tumor and adjacent normal tissues, as well as their correlation in modulating intratumoral steroid-hormone levels in post-menopausal estrogen-depende...
Source: The Journal of Steroid Biochemistry and Molecular Biology - Category: Biochemistry Source Type: research
CONCLUSION(S): QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation. PMID: 31591636 [PubMed - as supplied by publisher]
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Oncol Source Type: research
ConclusionsCanadian pts represent a diverse population. Interim safety and efficacy results are generally consistent with the overall study: response rate - 21.1% for Canada v.s. 20.5% overall; clinical benefit rate - 66.1% Canada v.s 66.1% Overall, safety results were consistent with those observed in RIBO pivotal studies and no new safety signals were observed.Clinical trial identificationNCT02941926.Legal entity responsible for the studyNovartis.FundingNovartis.DisclosureC. Ferrario: Honoraria (self), Research grant / Funding (institution): Pfizer; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsInitial results from the Spanish cohort in CompLEEment-1 are consistent with previous data showing efficacy and a manageable safety profile of ribociclib plus letrozole as a first-line treatment option in a diverse group of patients with HR+, HER2 – ABC. Acknowledgement: Dr. J. Gavilá-Gregori, Dr. M.J. Martinez-Serrano and Dr. M. Perelló contributed equally to this study.Clinical trial identificationNCT02941926.Legal entity responsible for the studyNovartis Pharmaceuticals Corporation.FundingNovartis Pharmaceuticals Corporation.DisclosureE.M. Ciruelos: Advisory / Consultancy, Speaker Bureau /...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundAdjuvant endocrine therapy (AET) is an important treatment for post-menopausal hormone receptor positive breast cancer. We used health administrative data to explore factors associated with AET adherence and survival.MethodsWe used health administrative databases to investigate adherence of post-menopausal women (aged ≥ 66 years) who started endocrine therapy from 2005-2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundApproximately 40% of pts with HR+, HER2 – ABC have mutations (mut) in PIK3CA, which encodes α-PI3K and leads to PI3K pathway hyperactivation and potentially ET resistance. ALP is a selective inhibitor of α-PI3K that, in combination with fulvestrant (FUL), significantly improved median progression-free survival (PFS) vs placebo + FUL i n pts with PIK3CA-mut, HR+ HER2– ABC in the phase 3 SOLAR-1 trial (11.0 vs 5.7 mo, respectively; HR 0.65; 95% CI, 0.50-0.85; P 
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundThe combination of a CDK4/6 inhibitor (CDK4/6i) with letrozole (LET) or fulvestrant (FUL) is the most active first –line (1L) treatment for patients (pts) with HR[+]/HER2[-] ABC. Although endocrine sensitivity persists beyond progression, preliminary findings suggest more adaptive resistance mechanisms to endocrine therapy (ET) than to CDK4/6i. At present, there are no data about prolonging CDK4/6 blockade bey ond progression on a CDK4/6i. The aim of this study is to determine whether palbociclib rechallenge combined with second–line ET upon progression to a prior palbociclib–based thera...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsThis study confirms that ER PAS in ER-positive patients, measured before and after neoadjuvant endocrine therapy, has potential to predict and assess therapy response, and predict DFS.Legal entity responsible for the studyPhilips Electronics Nederland B.V., acting through its HealthWorks Molecular Pathway Dx.FundingHas not received any funding.DisclosureM. A. Inda: Full / Part-time employment: Philips Reseach. A. van de Stolpe: Full / Part-time employment, has Philips stocks: Philips Research. D. Keizer: Full / Part-time employment: Philips. D. Clout: Full / Part-time employment: Philips Reasearch. H. van Zon: F...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractPurposeAdherence to adjuvant endocrine therapy among post-menopausal breast cancer patients is an important survivorship care issue. We explored factors associated with endocrine therapy adherence and survival in a large real-world population-based study.MethodsWe used health administrative databases to follow women (aged ≥ 66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2010. Adherence was measured by medical possession ratio (MPR) and characterized as low (
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
CONCLUSION: Transcriptomic profiling identifies patients with an excellent outcome without any systemic adjuvant therapy in clinically low-risk patients of the SweBCG91-RT and METABRIC cohorts. PMID: 31558478 [PubMed - as supplied by publisher]
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
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