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Title: Anastrozole An Option For Postmenopausal Hormone-Sensitive Early Breast Cancer

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Lancet 2002; 359: 2131-39.
06/21/2002 08:05:00 AM
By Harvey McConnell

Anastrozole appears to be an effective and well tolerated endocrine option for the treatment of postmenopausal women with hormone-sensitive early breast cancer. Based on results from an international trial of 9366 women from 21 countries, researchers believe that doctors now have a choice of anastrozole or tamoxifen therapy. The women were divided into three groups: 3,125 were randomly assigned anastrozole, 3,116 tamoxifen, and 3,125 a combination of the two. Median follow-up was 33.3 months. In the fast track report, lead author Dr Michael Baum from the Cancer Trials Center, University College London, England, points out that tamoxifen therapy for five years after surgery is the established treatment for postmenopausal women with hormone-sensitive breast cancer. However, there are several associated side effects, including endometrial cancer and thromboembolic disorders. Among the study participants, clinicians found three-year disease-free survival was 2 percent greater among women given anastrozole (89.4 percent), compared with those given tamoxifen (87.4 percent). Combination therapy showed no additional benefit compared with women given tamoxifen. Anastrozole was better tolerated than tamoxifen with respect to endometrial cancer, vaginal bleeding and discharge, stroke, venous thromboembolic events, and hot flushes. Tamoxifen was significantly better tolerated than anastrozole with respect to musculoskeletal disorders and bone fractures. The clinicians make it clear that the trial did not investigate the use of anastrozole in sequence after initiation of adjuvant treatment with tamoxifen treatment: "These data cannot, therefore, be used to recommend that patients already being treated with tamoxifen should be switched to anastrozole. This question on sequencing is the subject of other ongoing clinical trials." The evidence so far, the clinicians add, is encouraging, and these results could be as significant to breast cancer treatment as the results first seen with tamoxifen nearly 20 years ago. "An important consideration at this time is how to treat newly diagnosed patients. An overall assessment of the benefits versus harm, based on current data, supports the use of anastrozole for the adjuvant treatment of early breast cancer in postmenopausal women, meaning that there is now a choice of adjuvant endocrine therapy for postmenopausal women with hormone-responsive tumors."

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