Source: Urology  |  Posted 10 years ago

By Ed Susman
Special to DG News
HOLLYWOOD, FL -- March 4, 2002 -- Guideline writers for a consortium of major US cancer treatment centers quickly responded to new clinical trial data that indicates the aromatase inhibitor anastrozole has a place in treating women with breast cancer.
"We have elevated the aromatase inhibitors, letrozole and anastrozole, and the aromatase inactivator, exemestane, to first-line treatment for postmenopausal patients with metastatic disease," said Robert Carlson, MD, professor of medicine at Stanford University Medical Center, during the 7th annual meeting of the National Comprehensive Cancer Network (NCCN)
Dr. Carlson said clinical studies indicate that the aromatase inhibitor may, in fact, be superior to tamoxifen and other treatments for metastatic disease. "However, we have put the aromatase inhibitor and tamoxifen at the same level for now, reflecting that we as clinicians have long-term experience with tamoxifen that we haven?t had yet with the aromatase drugs."
He indicated that if the aromatase inhibitors continue to show effectiveness and produce no surprises in adverse events, future iterations of the guidelines might differentiate between the drugs.
In the seven years that the doctors for the 19-member NCCN have met, the breast cancer guidelines have always undergone revision. In general, the guidelines written specifically for individual diseases are revised every three years.
Another change in the guidelines reflected the results of the ATAC (Anastrozole, Tamoxifen, Alone or in Combination) study that were released in December at the San Antonio (Texas) Breast Cancer Symposium, which showed the benefits of using anastrozole over tamoxifen in postmenopausal women in the adjuvant setting.
"Early evidence for a single, large, placebo-controlled, randomized clinical trial demonstrates that anastrozole provides superior disease-free survival and a favorable toxicity profile compared to tamoxifen as adjuvant therapy for hormone receptor positive breast cancer in postmenopausal women," wrote the guideline panel, headed by Dr. Carlson.
"Additional follow-up of this trial and additional experience is required before definitive conclusions can be made," the panel added. "At the current time, anastrozole may be considered as an option to tamoxifen after discussion of the available data between the physician and patients.
"These data do not address whether women currently on tamoxifen should be changed to anastrozole. Anastrozole is not appropriate therapy for premenopausal women."