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Long-term efficacy and safety of letrozole for the adjuvant treatment of early breast cancer in postmenopausal women: a review.

Monnier A - Ther Clin Risk Manag (2009)

Bottom Line: Letrozole also significantly reduces the occurrence of early distant metastases, the most lethal type of recurrence event, which can lead to improved survival.Clinical comparisons of letrozole with both tamoxifen and placebo have also provided important long-term safety data on the use of AIs as adjuvant therapy in PMW with EBC.The weight of clinical evidence indicates that letrozole is a safe and effective option for adjuvant hormonal therapy across all three AI treatment settings.

View Article: PubMed Central - PubMed

Affiliation: Institut Régional Fédératif du Cancer (IFRC), Centre Hospitalier Belfort-Montbéliard, Montbéliard, France.

ABSTRACT
Aromatase inhibitors (AIs) are becoming more widely used than tamoxifen as adjuvant hormonal therapy for postmenopausal women (PMW) with early breast cancer (EBC). It is clear that these drugs offer important efficacy benefits over tamoxifen and differ from tamoxifen in their safety profile. The accepted strategies for adjuvant AI therapy include initial adjuvant treatment following surgery, switching and/or sequencing from prior tamoxifen, and extended adjuvant therapy following the full 5 years of tamoxifen treatment. Among the available AIs, letrozole has been evaluated in large, well-controlled, double-blind clinical trials in the initial adjuvant, extended adjuvant, and more recently, the sequential adjuvant settings. Letrozole is the most potent of the AIs and provides near complete suppression of plasma estrogens in PMW. Letrozole also significantly reduces the occurrence of early distant metastases, the most lethal type of recurrence event, which can lead to improved survival. Clinical comparisons of letrozole with both tamoxifen and placebo have also provided important long-term safety data on the use of AIs as adjuvant therapy in PMW with EBC. The weight of clinical evidence indicates that letrozole is a safe and effective option for adjuvant hormonal therapy across all three AI treatment settings.

No MeSH data available.


Related in: MedlinePlus

(A) Comparison of residual estrogen fractions in plasma following 6 weeks’ treatment with letrozole or anastrozole. The difference in suppression was significant for each fraction (for estradiol, P = 0.018; for estrone, P = 0.003; for estrone sulfate, P = 0.003).16 (B) Comparison of residual estrogen fractions in tumor tissue following 16 weeks’ neoadjuvant treatment with letrozole or anastrozole (P values not reported). Drawn from data of Geisler et al 2008.16
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f3-tcrm-5-725: (A) Comparison of residual estrogen fractions in plasma following 6 weeks’ treatment with letrozole or anastrozole. The difference in suppression was significant for each fraction (for estradiol, P = 0.018; for estrone, P = 0.003; for estrone sulfate, P = 0.003).16 (B) Comparison of residual estrogen fractions in tumor tissue following 16 weeks’ neoadjuvant treatment with letrozole or anastrozole (P values not reported). Drawn from data of Geisler et al 2008.16

Mentions: The difference in outcome between ATAC and BIG 1–98, as noted above, is illustrative of the impact of early DM reduction on survival and also suggests a potential difference in efficacy between these two nonsteroidal AIs. Indeed, there is evidence for a greater suppression of both plasma and tissue estrogen levels with letrozole compared with anastrozole treatment (Figure 3).16–18 While ATAC and BIG 1–98 are not directly comparable because of differences in design and follow-up, a recently completed trial, the Femara Anastrozole Clinical Evaluation (FACE), has compared the efficacy and safety of initial adjuvant treatment with these agents in a head-to-head fashion in a population of PMW with HR+, N+, EBC.24,25 The forthcoming results of this trial, once available, should provide, for the first time, a directly comparative assessment of both efficacy and safety for these two AIs in the important high-risk population of N+ EBC patients.


Long-term efficacy and safety of letrozole for the adjuvant treatment of early breast cancer in postmenopausal women: a review.

Monnier A - Ther Clin Risk Manag (2009)

(A) Comparison of residual estrogen fractions in plasma following 6 weeks’ treatment with letrozole or anastrozole. The difference in suppression was significant for each fraction (for estradiol, P = 0.018; for estrone, P = 0.003; for estrone sulfate, P = 0.003).16 (B) Comparison of residual estrogen fractions in tumor tissue following 16 weeks’ neoadjuvant treatment with letrozole or anastrozole (P values not reported). Drawn from data of Geisler et al 2008.16
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2747391&req=5

f3-tcrm-5-725: (A) Comparison of residual estrogen fractions in plasma following 6 weeks’ treatment with letrozole or anastrozole. The difference in suppression was significant for each fraction (for estradiol, P = 0.018; for estrone, P = 0.003; for estrone sulfate, P = 0.003).16 (B) Comparison of residual estrogen fractions in tumor tissue following 16 weeks’ neoadjuvant treatment with letrozole or anastrozole (P values not reported). Drawn from data of Geisler et al 2008.16
Mentions: The difference in outcome between ATAC and BIG 1–98, as noted above, is illustrative of the impact of early DM reduction on survival and also suggests a potential difference in efficacy between these two nonsteroidal AIs. Indeed, there is evidence for a greater suppression of both plasma and tissue estrogen levels with letrozole compared with anastrozole treatment (Figure 3).16–18 While ATAC and BIG 1–98 are not directly comparable because of differences in design and follow-up, a recently completed trial, the Femara Anastrozole Clinical Evaluation (FACE), has compared the efficacy and safety of initial adjuvant treatment with these agents in a head-to-head fashion in a population of PMW with HR+, N+, EBC.24,25 The forthcoming results of this trial, once available, should provide, for the first time, a directly comparative assessment of both efficacy and safety for these two AIs in the important high-risk population of N+ EBC patients.

Bottom Line: Letrozole also significantly reduces the occurrence of early distant metastases, the most lethal type of recurrence event, which can lead to improved survival.Clinical comparisons of letrozole with both tamoxifen and placebo have also provided important long-term safety data on the use of AIs as adjuvant therapy in PMW with EBC.The weight of clinical evidence indicates that letrozole is a safe and effective option for adjuvant hormonal therapy across all three AI treatment settings.

View Article: PubMed Central - PubMed

Affiliation: Institut Régional Fédératif du Cancer (IFRC), Centre Hospitalier Belfort-Montbéliard, Montbéliard, France.

ABSTRACT
Aromatase inhibitors (AIs) are becoming more widely used than tamoxifen as adjuvant hormonal therapy for postmenopausal women (PMW) with early breast cancer (EBC). It is clear that these drugs offer important efficacy benefits over tamoxifen and differ from tamoxifen in their safety profile. The accepted strategies for adjuvant AI therapy include initial adjuvant treatment following surgery, switching and/or sequencing from prior tamoxifen, and extended adjuvant therapy following the full 5 years of tamoxifen treatment. Among the available AIs, letrozole has been evaluated in large, well-controlled, double-blind clinical trials in the initial adjuvant, extended adjuvant, and more recently, the sequential adjuvant settings. Letrozole is the most potent of the AIs and provides near complete suppression of plasma estrogens in PMW. Letrozole also significantly reduces the occurrence of early distant metastases, the most lethal type of recurrence event, which can lead to improved survival. Clinical comparisons of letrozole with both tamoxifen and placebo have also provided important long-term safety data on the use of AIs as adjuvant therapy in PMW with EBC. The weight of clinical evidence indicates that letrozole is a safe and effective option for adjuvant hormonal therapy across all three AI treatment settings.

No MeSH data available.


Related in: MedlinePlus