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Anastrazole Could Supplant Tamoxifen For Advanced Breast Cancer Treatment
A DGReview of :"Anastrozole Is Superior to Tamoxifen as First-Line Therapy for Advanced Breast Cancer in Postmenopausal Women: Results of a North American Multicenter Randomized Trial"
Cancer Research
11/20/2000
By David Loshak
New clinical trial data clearly support the use of the new generation aromatase inhibitor, anastrozole (Arimidex), as an alternative to tamoxifen for the first-line treatment of hormone-responsive advanced breast cancer in postmenopausal women.
It is at least as effective as tamoxifen, according to the Arimidex Study Group of oncologists.
"This is the first time that we see something which could be better than tamoxifen," said the lead investigator, Professor Jean-Marc Nabholtz. "Usually in medical oncology there is a toxicity price to pay for something better, but in this case there is no trade-off."
Anastrozole has been established since 1995 as a second-line treatment after failure of tamoxifen in postmenopausal women with advanced breast cancer. It has now satisfied the predefined criteria for equivalence to tamoxifen in first-line treatment, Prof. Nabholtz reports.
The efficacy and tolerability of anastrozole 1 mg/day and tamoxifen 20 mg/day were compared as first-line therapy for advanced breast cancer in a randomised, double-blind study.
The study enrolled 353 postmenopausal women at 97 centres who were eligible for endocrine therapy and had hormone receptor-positive tumours or tumours of unknown receptor status.
Objective response with anastrozole was 21 percent compared to 17 percent with tamoxifen. There was clinical benefit (complete response plus partial response plus stabilisation at 24 weeks) in 59 percent of anastrozole patients compared with 46 percent of tamoxifen patients.
Median time to progression with anastrozole was 11.1 months, giving it a significant advantage over tamoxifen's 5.6 months.
The tamoxifen:anastrozole hazards ratio was 1.44. Both treatments were well tolerated.
With anastrozole, 4.1 percent of patients experienced thromboembolic events and 1.2 percent had vaginal bleeding. In patients receiving tamoxifen, these unwanted effects occurred two to three times as often, with thromboembolic events in 8.2 percent of recipients and vaginal bleeding in 3.8 percent.
"Anastrozole Is Superior to Tamoxifen as First-Line Therapy for Advanced Breast Cancer in Postmenopausal Women: Results of a North American Multicenter Randomized Trial"
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