DOI: 10.1634/theoncologist.8-4-335. Advances in Endocrine Treatments for Postmenopausal Women with Metastatic and Early Breast Cancer

Advances in Endocrine Treatments for Postmenopausal Women with Metastatic and Early Breast Cancer

10.1634/theoncologist.8-4-335

Crossref journal-article

Oxford University Press (OUP)

The Oncologist (286)

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Define appropriate candidates for various endocrine therapies. Discuss the choices of therapies for patients with advanced breast cancer. Assess the options for adjuvant endocrine therapy for postmenopausal women. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com For the past 25 years, the estrogen antagonist tamoxifen has been the hormonal treatment of choice for postmenopausal patients with hormone-sensitive metastatic and early breast cancer (EBC). However, tamoxifen is associated with certain tolerability and safety concerns. In addition, the hormonal options after progression are limited, and thus, alternative endocrine treatments have been developed. This review provides a synopsis of the newer alternatives in endocrine therapy of breast cancer: the aromatase inhibitors (AIs) and fulvestrant Faslodex®, the estrogen receptor antagonist that downregulates estrogen and progesterone receptors and has no known agonist activity. The third-generation AIs, anastrozole and letrozole, have been shown to be as effective or more effective than megestrol acetate and tamoxifen as second- and first-line therapies for the treatment of postmenopausal patients with metastatic breast cancer, and exemestane has been approved for second-line use. Fulvestrant has been shown to be as effective as anastrozole as second-line therapy for metastatic breast cancer and has been approved in the U.S. for the treatment of postmenopausal women with hormone-receptor-positive metastatic breast cancer following progression on antiestrogen therapy. Anastrozole is the only AI with published clinical trial data and U.S. Food and Drug Administration approval for adjuvant therapy of postmenopausal women with EBC. The ‘Arimidex,’ Tamoxifen, Alone or in Combination (ATAC) trial, a double-blind, multicenter trial with 9,366 patients, compared tamoxifen with anastrozole, alone and in combination, as adjuvant endocrine treatment for postmenopausal patients with operable, invasive, EBC. The first analysis (at a median follow-up of 33.3 months) showed longer disease-free survival and, in general, better tolerability with anastrozole than with tamoxifen. This pattern was maintained at later analyses with a median follow-up of 47 months for efficacy and 37 months for safety and tolerability. Although longer follow-up is warranted, anastrozole appears to be a well-documented choice of endocrine adjuvant therapy for postmenopausal women with hormone-responsive breast cancer.

Bibliography

Buzdar, A. U. (2003). Advances in Endocrine Treatments for Postmenopausal Women with Metastatic and Early Breast Cancer. The Oncologist, 8(4), 335â341.

Authors 1

Aman U. Buzdar (first)

References 26 Referenced 56

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{'key': '2021122209331444500_R2', 'first-page': '134', 'article-title': 'Inhibition of human mammary and prostatic cancer by adrenalectomy', 'volume': '12', 'author': 'Huggins', 'year': '1952', 'journal-title': 'Cancer Res'} / Cancer Res / Inhibition of human mammary and prostatic cancer by adrenalectomy by Huggins (1952)
10.1093/jnci/88.21.1529 / J Natl Cancer Inst / Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors by Fisher (1996)
10.1200/JCO.1995.13.2.513 / J Clin Oncol / Use of tamoxifen for breast cancer: twenty-eight years later by Jaiyesimi (1995)
10.1097/00000658-197805000-00004 / Ann Surg / Medical adrenalectomy with aminoglutethimide: clinical studies in postmenopausal patients with metastatic breast carcinoma by Wells (1978)
{'key': '2021122209331444500_R6', 'first-page': '4823', 'article-title': 'Treatment of advanced postmenopausal breast cancer with the aromatase inhibitor, 4-hydroxyandrostenedione: phase II report', 'volume': '46', 'author': 'Goss', 'year': '1986', 'journal-title': 'Cancer Res'} / Cancer Res / Treatment of advanced postmenopausal breast cancer with the aromatase inhibitor, 4-hydroxyandrostenedione: phase II report by Goss (1986)
10.1016/S0959-8049(01)81042-X / Eur J Cancer / ICI 182,780 (Faslodex™) versus anastrozole (Arimidex™) for the treatment of advanced breast cancer in postmenopausal women: prospective combined analysis of two multicenter trials by Howell (2001)
10.1200/JCO.2002.10.057 / J Clin Oncol / Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment by Howell (2002)
10.1200/JCO.2002.10.058 / J Clin Oncol / Double-blind, randomized trial comparing the efficacy and tolerability of fulvestrant versus anastrozole in postmenopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial by Osborne (2002)
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10.1002/(SICI)1097-0142(19980915)83:6<1142::AID-CNCR13>3.0.CO;2-5 / Cancer / Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Arimidex Study Group by Buzdar (1998)
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{'key': '2021122209331444500_R19', 'first-page': '29a', 'article-title': 'Efficacy of and tolerance to exemestane (E) versus tamoxifen (T) in first-line hormone therapy (HT) of postmenopausal metastatic breast cancer (MBC) patients (pts): a European Organisation for the Research and Treatment of Cancer (EORTC Breast Group) phase II trial with Pharmacia and Upjohn', 'volume': '20', 'author': 'Dirix', 'year': '2001', 'journal-title': 'Proc Am Soc Clin Oncol'} / Proc Am Soc Clin Oncol / Efficacy of and tolerance to exemestane (E) versus tamoxifen (T) in first-line hormone therapy (HT) of postmenopausal metastatic breast cancer (MBC) patients (pts): a European Organisation for the Research and Treatment of Cancer (EORTC Breast Group) phase II trial with Pharmacia and Upjohn by Dirix (2001)
{'key': '2021122209331444500_R20', 'first-page': '46', 'article-title': 'Fulvestrant versus tamoxifen for the first-line treatment of advanced breast cancer (ABC) in postmenopausal women', 'volume': '13', 'author': 'Robertson', 'year': '2002', 'journal-title': 'Ann Oncol'} / Ann Oncol / Fulvestrant versus tamoxifen for the first-line treatment of advanced breast cancer (ABC) in postmenopausal women by Robertson (2002)
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{'issue': 'suppl 1', 'key': '2021122209331444500_R23', 'first-page': 'S156', 'article-title': "Beneficial side-effect profile of anastrozole compared with tamoxifen confirmed by additional 7 months of exposure data: a safety update from the ’Arimidex’, Tamoxifen, Alone or in Combination (ATAC) trial. ATAC Trialists' Group", 'volume': '76', 'author': 'Sainsbury', 'year': '2002', 'journal-title': 'Breast Cancer Res Treat'} / Breast Cancer Res Treat / Beneficial side-effect profile of anastrozole compared with tamoxifen confirmed by additional 7 months of exposure data: a safety update from the ’Arimidex’, Tamoxifen, Alone or in Combination (ATAC) trial. ATAC Trialists' Group by Sainsbury (2002)
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Dates

Type	When
Created	21 years ago (Aug. 24, 2004, 5:38 p.m.)
Deposited	3 years, 8 months ago (Dec. 22, 2021, 11:46 a.m.)
Indexed	11 months, 3 weeks ago (Sept. 11, 2024, 12:36 a.m.)
Issued	22 years, 1 month ago (Aug. 1, 2003)
Published	22 years, 1 month ago (Aug. 1, 2003)
Published Online	22 years, 1 month ago (Aug. 1, 2003)
Published Print	22 years, 1 month ago (Aug. 1, 2003)

Funders 0

None

BibTeX

@article{Buzdar_2003, title={Advances in Endocrine Treatments for Postmenopausal Women with Metastatic and Early Breast Cancer}, volume={8}, ISSN={1549-490X}, url={http://dx.doi.org/10.1634/theoncologist.8-4-335}, DOI={10.1634/theoncologist.8-4-335}, number={4}, journal={The Oncologist}, publisher={Oxford University Press (OUP)}, author={Buzdar, Aman U.}, year={2003}, month=aug, pages={335–341} }

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