Journal ArticleDOI
Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses
Michael Baum,Aman U. Buzdar,Jack Cuzick,John F. Forbes,Joan Houghton,Anthony Howell,T Sahmoud +6 more
TLDR
The results of the first efficacy update are reported along with the results of an updated safety analysis, performed 7 months after the first analysis, based on a median follow‐up period of 47 months.Abstract:
BACKGROUND: The first analysis of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial (median follow-up, 33 months) demonstrated that in adjuvant endocrine therapy for postmenopausal patients with early-stage breast cancer, anastrozole was superior to tamoxifen in terms of disease-free survival (DFS), time to recurrence (TTR), and incidence of contralateral breast cancer (CLBC). In the current article, the results of the first efficacy update, based on a median follow-up period of 47 months, are reported along with the results of an updated safety analysis, performed 7 months after the first analysis (median duration of treatment, 36.9 months). METHODS: DFS, TTR, CLBC incidence, and safety were assessed in the same patient group as in the first analysis of the ATAC trial. RESULTS: DFS estimates at 4 years remained significantly more favorable (86.9% vs. 84.5%, respectively) for patients receiving anastrozole compared with those receiving tamoxifen (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.76-0.99; P = 0.03). The benefit generated by anastrozole in terms of DFS was even greater in patients with hormone receptor-positive tumors (HR, 0.82; 95% CI, 0.70-0.96; P = 0.014). The HR for TTR also indicated a significant benefit for patients receiving anastrozole compared with those receiving tamoxifen (HR, 0.83; 95% CI, 0.71-0.96; P = 0.015), with additional benefit for patients with hormone receptor-positive tumors (HR, 0.78; 95% CI, 0.65-0.93; P = 0.007). CLBC incidence data also continued to favor anastrozole (odds ratio [OR], 0.62; 95% CI, 0.38-1.02; P = 0.062), and statistical significance was achieved in the hormone receptor-positive subgroup (OR, 0.56; 95% CI, 0.32-0.98; P = 0.042). The updated safety analysis also confirmed the findings of the first analysis, in that endometrial cancer (P = 0.007), vaginal bleeding and discharge (P < 0.001 for both), cerebrovascular events (P < 0.001), venous thromboembolic events (P < 0.001), and hot flashes (P < 0.001) all occurred less frequently in the anastrozole group, whereas musculoskeletal disorders and fractures (P < 0.001 for both) continued to occur less frequently in the tamoxifen group. These results indicated that the safety profile of anastrozole remained consistent. CONCLUSIONS: After an additional follow-up period, anastrozole continues to show superior efficacy, which is most apparent in the clinically relevant hormone receptor-positive population. Furthermore, anastrozole has numerous noteworthy advantages in terms of tolerability compared with tamoxifen. These findings suggest that the benefits of anastrozole are likely to be maintained in the long term and provide further support for the status of anastrozole as a valid treatment option for postmenopausal women with hormone-sensitive early-stage breast cancer. Copyright 2003 American Cancer Society.read more
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Journal ArticleDOI
Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer
TL;DR: Anastrozole should be the preferred initial treatment for postmenopausal women with localised hormone-receptor-positive breast cancer, especially gynaecological problems and vascular events, but arthralgia and fractures were increased.
Journal ArticleDOI
A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer
Beat Thürlimann,Aparna Keshaviah,Alan S. Coates,Henning T. Mouridsen,Louis Mauriac,John F. Forbes,Robert Paridaens,Monica Castiglione-Gertsch,Richard D. Gelber,Manuela Rabaglio,Ian E. Smith,Andrew M Wardley,Karen N. Price,Aron Goldhirsch +13 more
TL;DR: In postmenopausal women with endocrine-responsive breast cancer, adjuvant treatment with letrozole, as compared with tamoxifen, reduced the risk of recurrent disease, especially at distant sites.
Journal ArticleDOI
Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial.
Jack Cuzick,Ivana Sestak,Michael Baum,Aman U. Buzdar,Anthony Howell,Mitch Dowsett,John F. Forbes +6 more
TL;DR: The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial as discussed by the authors was designed to compare the efficacy and safety of anastrozole (1 mg) with tamioxifen (20 mg) as adjuvant treatment for postmenopausal women with early stage breast cancer.
Journal ArticleDOI
American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor–Positive Breast Cancer: Status Report 2004
Eric P. Winer,Clifford A. Hudis,Harold J. Burstein,Antonio C. Wolff,Kathleen I. Pritchard,James N. Ingle,Rowan T. Chlebowski,Richard D. Gelber,Stephan B. Edge,Julie Gralow,Melody A. Cobleigh,Eleftherios P. Mamounas,Lori J. Goldstein,Timothy J. Whelan,Trevor J. Powles,John Bryant,Cheryl L. Perkins,Judy Perotti,Susan Braun,Amy S. Langer,George P. Browman,Mark R. Somerfield +21 more
TL;DR: It is believed that optimal adjuvant hormonal therapy for a postmenopausal woman with receptor-positive breast cancer includes an aromatase inhibitor as initial therapy or after treatment with tamoxifen.
Journal ArticleDOI
Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials
TL;DR: Recurrence RRs favoured aromatase inhibitors during periods when treatments differed, but not significantly thereafter, and 10-year breast cancer mortality was lower with switching to arom atase inhibitors than with remaining on tamoxifen, and there were fewer recurrences in these trials.
References
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Journal ArticleDOI
Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial.
TL;DR: Anastrozole is an effective and well tolerated endocrine option for the treatment of postmenopausal patients with hormone-sensitive early breast cancer and longer follow-up is required before a final benefit:risk assessment can be made.
Journal ArticleDOI
The ATAC ('Arimidex', Tamoxifen, Alone or in Combination) Trial in Postmenopausal Women with Early Breast Cancer – Updated Efficacy Results Based on a Median Follow-up of 47 Months
TL;DR: The results of the first efficacy update based on a median follow-up of 47 months (for DFS) are reported, a total of 1373 first events had occurred, these being summarised below.
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