Survival outcome and treatment tolerability for postmenopausal females with early stage hormone receptor positive breast cancer treated with different adjuvant hormonal lines (TAM vs. AI vs. switching strategy) for 5 years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Atef Youssef Riyad ◽  
Dalia Abdelghany Elkhodary ◽  
Wesam Reda Farag Elghamry ◽  
Islam Abdelrahman Kamel Mohamed Zaki
Keyword(s):  
Breast Cancer ◽  
Aromatase Inhibitor ◽  
Early Breast Cancer ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Disease Free Survival ◽  
Hormonal Treatment ◽  
Hormone Receptor Positive ◽  
Adjuvant Hormonal Treatment ◽  
Her 2

Abstract Background The standard adjuvant endocrine treatment for postmenopausal female patients with hormone receptor positive early breast cancer was 5 years of tamoxifen, but recurrence and side effects restrict its usefulness. The aromatase inhibitor (anastrozole or exemestane or letrozole) was compared with tamoxifen for 5 years or started after completing 2-3 years of tamoxifen in postmenopausal female patients diagnosed with early breast cancer at "Ain Shams University Hospitals" Objective The aim of the study was to measure survival outcome and treatment tolerability for postmenopausal females with Hormone Receptor Positive early breast cancer who received adjuvant hormonal treatment with tamoxifen [TAM] only for 5 years versus those who received adjuvant hormonal treatment with tamoxifen [TAM] for 2 years switching to aromatase inhibitors [AI] in the sequential 3 years versus those who received adjuvant hormonal treatment with aromatase inhibitors [AI] solely for 5 years. Patients and methods This study included 100 postmenopausal women with early breast cancer who presented at the Clinical Oncology Department, Ain Shams University, in the interval from January 2010 until December 2015. Conclusion Similar disease free survival and overall survival were observed among the three studied groups. Switching tamoxifen to aromatase inhibitors provides better tolerability in terms of endometrial thickness when compared to 5 years of tamoxifen monotherapy. Patients who administer aromatase inhibitor included in the switching strategy experience less osteoporosis and less generalized bone pain compared to upfront aromatase inhibitor to 5 years. There was a significant improvement of disease free survival (DFS) in human epidermal growth factor receptor 2 (HER 2) negative patients receiving any adjuvant hormonal treatment line for five years in comparison to HER 2 positive patients receiving the same adjuvant hormonal treatment for five years.

scholarly journals From Theory to Practice: Bone Health in Women with Early Breast Cancer Treated with Aromatase Inhibitors

2021 ◽  
Vol 28 (2) ◽  
pp. 1067-1076
Author(s):  
Leonor Vasconcelos de Matos ◽  
Leonor Fernandes ◽  
Maria Teresa Neves ◽  
Fátima Alves ◽  
Mafalda Baleiras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Aromatase Inhibitors ◽  
Bone Health ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Hormone Receptor Positive ◽  
Fracture Cohort ◽  
Fracture Event ◽  
Post Menopausal

Aromatase inhibitors (AI) are extensively used as adjuvant endocrine therapy in post-menopausal women with hormone receptor-positive early breast cancer (HR+ EBC), but their impact on bone health is not negligible. This work aimed to assess bone loss, fracture incidence, and risk factors associated with these events, as well as the prognostic influence of fractures. We have conducted a retrospective cohort study of women with HR+ EBC under adjuvant therapy with AI, during a 3-year period. Four-hundred-and-fifty-one eligible women were reviewed (median age 68 years). Median time under AI was 40 months. A fracture event occurred in 8.4%, mostly in the radium and femoral neck and in older women (mean 74 vs. 68 years, p = 0.006). Age (OR 1.01, 95% CI 1.01–1.07, p = 0.024) and time under AI (OR 1.02, 95% CI 1.00–1.04, p = 0.037) were independent predictors of fracture, with a fair discrimination (AUC 0.71). Analysis of disease-free survival according to fracture event varied between groups, disfavoring the fracture cohort (at 73 months, survival 78.6%, 95% CI, 47.6–92.4 vs. 95.6%, 95% CI, 91.2–97.8, p = 0.027). The multivariate model confirmed the prognostic impact of fracture occurrence (adjusted HR of 3.17, 95% CI 1.10–9.11; p = 0.032). Bone health is often forgotten, despite its great impact in survivorship. Our results validate the pathophysiologic link between EBC and bone metabolism, which translates into EBC recurrence. Further research in this area may help refine these findings. Moreover, early identification of women at higher risk for fractures is warranted.

Adjuvant Aromatase Inhibitors for Early Breast Cancer After Chemotherapy-Induced Amenorrhoea: Caution and Suggested Guidelines

2006 ◽  
Vol 24 (16) ◽  
pp. 2444-2447 ◽  
Author(s):  
Ian E. Smith ◽  
Mitch Dowsett ◽  
Yoon-Sim Yap ◽  
Geraldine Walsh ◽  
Per E. Lønning ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Early Breast Cancer ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Ovarian Function ◽  
Younger Women ◽  
Hormone Receptor Positive ◽  
Highly Sensitive ◽  
Positive Breast Cancer

Purpose Aromatase inhibitors (AIs) are now established as adjuvant therapy for early hormone receptor–positive breast cancer in postmenopausal women. Their use is sometimes extended to younger women after chemotherapy-induced amenorrhoea; we have audited this in one institution's breast unit, and we propose guidelines for use in such circumstances. Patients and Methods The use of aromatase inhibitors as adjuvant therapy in younger women age ≥ 40 with hormone receptor–positive early breast cancer and chemotherapy-induced amenorrhea has been audited clinically and biochemically. Results A total of 45 such women were identified in the audit, with a median age of 47 years (range, 39 to 52 years). Twelve women (27%) showed a return of ovarian function (10 renewed menses, one pregnancy, one biochemically premenopausal) after starting an AI. Median age at restart of ovarian function was 44 years (range, 40 to 50 years). Conclusion AIs may promote recovery of ovarian function in some women with chemotherapy-induced amenorrhea and should be used with caution. Biochemical monitoring of ovarian function requires highly sensitive immunoassays. Guidelines for the selection and delivery of adjuvant endocrine therapy in such patients are proposed.

Comparison of the efficacy of adjuvant letrozole and anastrozole in hormone-receptor positive postmenopausal breast cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11554-e11554
Author(s):  
Mehmet Ali Nahit Sendur ◽  
Sercan Aksoy ◽  
Kadri Altundag
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Postmenopausal Breast Cancer ◽  
Breast Cancer Patients ◽  
Hormone Receptor Positive ◽  
The Mean

e11554 Background: In the adjuvant hormonal treatment of postmenopausal breast cancer patients, most of the trials have showed the superiority of aromatase inhibitors over tamoxifen. However, there are limited data in the literature comparing the efficacy of aromatase inhibitors in postmenopausal women. Thus, the aim of this study is to compare the efficacy of letrozole and anastrozole in hormone-receptor positive postmenopausal breast cancer patients. Methods: Newly diagnosed breast cancer patients from 2001 to 2012 in our clinic were retrospectively analyzed. A total 566 hormone receptor-positive postmenopausal breast cancer patients were analyzed. The patients were divided into two group; anastrozole group (n=235) and letrozole patients (n=331). Kaplan–Meier survival analysis was carried out for disease free survival (DFS) and overall survival (OS). The log-rank test was used to examine the statistical significance of the differences observed between the groups. Results: The mean age was 59.2±8.5 in anastrozole group, and 60.1±8.4 in letrozole arm (P = 0.19). The mean BMI was 29.4±5.1 kg/m2 and 29.3±5.3 kg/m2 of anastrozole and letrozole arm, respectively (P =0.84). The median follow-up time for this analysis was 25.1 months. The histology of the primary tumor and type of surgery was similar and not statistically significant in both groups. Also in both arms the incidence of lymphovascular invasion, perineural invasion, HER2 positivity and histological grade were similar and not statistically significant. There were no apparent differences in baseline nodal status (P = 0.43), tumor size (P = 0.58) and tumor stage (P = 0.15) between two treatment arms. In anastrozole arm DFS rate was 93.7%, 81.3% and 66.0% whereas in letrozole arm DFS rate was 90.6%, 78.7% and 68.5% in the first, third and fifth years respectively. Median OS could not be obtained due to low events in both groups. Three year survival rate in anastrozole group was 98.8%, whereas in letrozole arm was 96.7% (P=0.84). Conclusions: In this retrospective study, the efficacy of letrozole and anastrozole was similar in hormone-receptor positive postmenopausal breast cancer patients.

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