A randomized phase III clinical trial (MA.17R) found that postmenopausal women with early breast cancer benefit from extending aromatase inhibitor (AI) therapy with letrozole (Femara) from 5 to 10 years.
“Women with early-stage hormone receptor-positive breast cancer face an indefinite risk of relapse,” said lead study author Paul Goss, MD, FRCP, PhD, and Director of Breast Cancer Research at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School, in a press release.1 “The study provides direction for many patients and their doctors, confirming that prolonging aromatase inhibitor therapy can further reduce the risk of breast cancer recurrences. Longer aromatase inhibitor therapy also showed a substantial breast cancer preventative effect in the opposite, healthy breast.”
According to the abstracts (LBA1 and LBA506) presented last week at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 3-7, 2016, in Chicago, the key points of the study illustrated.1 The study was also recently published in The New England Journal of Medicine.2
Women in the prolonged letrozole group had a 34% lower risk of recurrence.
The annual incidence of contralateral breast cancer was lower in the letrozole group than in the placebo group.
Overall, there were no significant differences in either overall quality of life between women who took letrozole for 5 years and those who received placebo. Patient overall quality of life was comparable between the two groups.
The trial enrolled 1,918 postmenopausal women who had received 5 years of any of the common aromatase inhibitor therapies. Ninety percent of this group began receiving letrozole or placebo within 6 months of completing prior therapy. In our own series, our medical oncology colleagues tell us that keeping women on hormonal therapies is quite challenging given some of the side effects that women many experience. Typical symptoms of arthralgias and other menopausal-like side effects keep women from completing treatment regimens even when given statistical information that might reduce recurrence.
While the literature indicates that a serial combination of aromatase inhibitors and tamoxifen have different toxicity profiles, one must carefully choose the approach carefully in patients with any given comorbidity.3
Endometrial cancer risk versus higher degrees of bone fracture is not a pleasant choice for most patients. After undergoing so many decisions about breast imaging, surgery and reconstruction, it is understandable that many women would not want to decide on two different hormonal therapies with a possible adverse consequence. Our job as clinicians and navigators will remain to educate patients, assist with decision making, and ensure timely follow-up.
American Society of Clinical Oncology. Ten Years of Hormone Therapy Reduces Breast Cancer Recurrence Without Compromising Quality of Life. News Releases, June 5, 2016.
Goss PE, Ingle JN, Pritchard KI, et al. Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. N Engl J Med, 2016 Jun 5.
Rydén L, Heibert Arnlind M, Vitols S, et al. Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo - Meta-analyses on efficacy and adverse events based on randomized clinical trials. Breast, 2016 Apr;26:106-14.
Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
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