Background: Aromatase inhibitors and inactivators have been extensively tested in patients with advanced breast cancer, but it is unclear whether they offer any survival benefits compared with standard hormonal treatment with tamoxifen or progestagens. Search for other works by this author on: Rockville, Maryland One reason for this finding may be enhanced bone density from the 5 years of tamoxifen that preceded letrozole.The study by Goss and colleagues explored the use of letrozole among women originally assigned to the placebo group in the MA.17 trial.
We used the searching algorithm (breast OR mammary) AND (cancer OR carcinoma OR neopl*) AND (aromatase OR aromatase inhibitors OR AIs OR aminoglutethimide OR formestane OR fadrozole OR anastrazole OR letrozole OR exemestane OR vorozole) AND (clinical trial OR randomized controlled trial OR double-blind OR single-blind OR single-blind OR random OR randomized OR placebo).We considered all randomized controlled trials to be eligible that compared an aromatase inhibitor or inactivator with tamoxifen or progestagens (such as medroxyprogesterone acetate, megestrol acetate, or fluoxymesterone) in patients with advanced breast cancer (i.e., metastatic and inoperable locally advanced or recurrent breast adenocarcinoma) in any line of treatment (first [front] line or second or subsequent line [in patients who had received such hormonal therapy in the past]). Epub 2017 Dec 21.Jacquet E, Lardy-Cléaud A, Pistilli B, Franck S, Cottu P, Delaloge S, Debled M, Vanlemmens L, Leheurteur M, Guizard AV, Laborde L, Uwer L, Jacot W, Berchery D, Desmoulins I, Ferrero JM, Perrocheau G, Courtinard C, Brain E, Chabaud S, Robain M, Bachelot T.Eur J Cancer. Gale KE, Andersen JW, Tormey DC, Mansour EG, Davis TE, Horton J, et al.

Median survival was not reached in the trials reported by Castelazo Rico et al. Falkson CI, Falkson HC. However, there was no benefit of AIs on DFS in the pS6K1 negative group (5 … 2011 Sep 7; 103(17):1299-309. Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. We also evaluated whether specific aromatase inhibitors had superior efficacy to standard hormonal therapy and whether the benefits, if present, extended over the first-line treatment and subsequent lines of treatment, regardless of the hormonal therapy used as comparator.We searched the Cochrane Central Trials Registry and PubMed without year and language restriction. Buzdar A, Douma J, Davidson N, Elledge R, Morgan M, Smith R, et al.

Amir E, Seruga B, Niraula S, Carlsson L, Ocaña A J Natl Cancer Inst. Open comparative trial of formestane versus megestrol acetate in postmenopausal patients with advanced breast cancer previously treated with tamoxifen. Based on the results, most doctors recommend that after initial treatment (surgery and possibly chemotherapy and radiation therapy): an aromatase …

At a median follow-up of 30 months, disease-free survival improved marginally (An editorial accompanying these studies describes trials still under way to assess the benefits and risks of aromatase inhibitors beyond 5 years of therapy.Overall, these three studies demonstrate that the extension of adjuvant endocrine therapy beyond the initial 5 years (in tamoxifen users) improves disease-free survival without impairing quality of life or causing major toxicity. Anastrozole versus tamoxifen as first-line therapy in postmenopausal patients with hormone-dependent advanced breast cancer: a prospective, randomized, phase III study. Higgins JP, Thompson SG. Aromatase is the enzyme that catalyzes a key aromatization step in the synthesis of estrogen. Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, et al. Search for other works by this author on: Clarke M, Stewart L, Pignon JP, Bijnens L. Individual patient data meta-analysis in cancer. North American Vorozole Study Group.

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