期刊
ANNALS OF ONCOLOGY
卷 22, 期 10, 页码 2201-2207出版社
OXFORD UNIV PRESS
DOI: 10.1093/annonc/mdq738
关键词
aromatase inhibitor; breast cancer; prognostic factor; tamoxifen
类别
资金
- Novartis [KG080081]
- National Cancer Institute at National Institutes of Health [CA075362]
- Swedish Cancer Society
- Cancer Council Australia
- Australian New Zealand Breast Cancer Trials Group
- Frontier Science and Technology Research Foundation
- Swiss Group for Clinical Cancer Research
- Foundation for Clinical Cancer Research of Eastern Switzerland
Background: On average, aromatase inhibitors are better than tamoxifen when used as initial or sequential therapy for postmenopausal women with endocrine-responsive early breast cancer. Because there may be contraindications to their use based on side-effects or cost, we investigated subgroups in which aromatase inhibitors may be more or less important. Patients and methods: Breast International Group 1-98 trial randomized 6182 women among four groups comparing letrozole and tamoxifen with sequences of each agent; 5177 (84%) had centrally confirmed estrogen receptor (ER) positivity. We assessed whether centrally determined ER, progesterone receptor (PgR), human epidermal growth factor receptor 2, and Ki-67 labeling index, alone or in combination with other prognostic features, predicted the magnitude of letrozole effectiveness compared with either sequence or tamoxifen monotherapy. Results: Individually, none of the markers significantly predicted differential treatment effects. Subpopulation treatment effect pattern plot analysis of a composite measure of prognostic risk revealed three patterns. Estimated 5-year disease-free survival for letrozole monotherapy, letrozole -> tamoxifen, tamoxifen -> letrozole, and tamoxifen monotherapy were 96%, 94%, 93%, and 94%, respectively, for patients at lowest risk; 90%, 91%, 93%, and 86%, respectively, for patients at intermediate risk; and 80%, 76%, 74%, and 69%, respectively, for patients at highest risk. Conclusion: A composite measure of risk informs treatment selection better than individual biomarkers and supports the choice of 5 years of letrozole for patients at highest risk for recurrence.
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