these studies add to the large body of existing data related to adjuvant endocrine therapy in premenopausal women with breast cancer and provide additional therapeutic options in those at high risk of disease recurrence. as is described in detail below, the determination of which premenopausal women should receive endocrine therapy in combination with os/oa is complex because of issues related to both efficacy and tolerability (see below, section contemporary trials of ovarian suppression). in contrast to these data, subgroup analyses of 105 patients with ciof in big 1-98, which compared letrozole with tamoxifen as front-line therapy in postmenopausal women, and women who were premenopausal at the time of tamoxifen initiation in ma.17, which compared letrozole versus placebo after five years of tamoxifen, identified no difference in breast cancer outcomes with ai therapy in these cohorts16,17. the risk of relapse in breast cancer varies over time and is dependent on a number of prognostic features including stage, histopathology, and hr status. however, there is a suggestion of a greater absolute reduction in recurrence rate with extended tamoxifen therapy in premenopausal women as compared to postmenopausal women (4.4 vs. 2.7%, chi-square p=0.79)4. in the nsabp b-14 study described above, analysis conducted by age (age <49 vs. >50) failed to demonstrate a difference in dfs between groups25.
the main outcomes of the austrian breast and colorectal study group (abcsg)-1232,33, suppression of ovarian function trial (soft)5, and the tamoxifen and exemestane trial (text)/soft joint analysis6 are shown in table 2. the abcsg-12 trial randomized 1803 hr+ premenopausal women with early stage breast cancer to goserelin plus tamoxifen or goserelin plus anastrozole with or without zoledronic acid. overall, the soft and text data provide compelling evidence that ai or tamoxifen plus os can significantly reduce the risk of recurrence compared to tamoxifen alone in premenopausal women at the highest risk for relapse (age <35 and those who maintain premenopausal status following chemotherapy). it is important to acknowledge that treatment with ten years of tamoxifen (as compared to five years) is associated with a further increase in uterine cancer and thromboembolic disease. for example, in atac, anastrozole or tamoxifen alone, as compared to the observed toxicity in soft/text, led to lower reported rates of hot flashes (30–32% with ai or tamoxifen alone in atac vs. 91–93% in soft/text), fatigue (16–20% vs. 61–62%) and dyspareunia (7–17% vs. 25–30%). in addition, optimization of therapy will require a continued dialogue between providers and patients, in order to maximize benefit while minimizing the negative impact on qol for younger breast cancer survivors. *** concurrent os was utilized in text which appeared to have slightly improved distant recurrence-free survival compared to soft (see text).
using a systematic review of the scientific literature (prospective and retrospective studies), we set out to assess the efficacy of ais compared with other endocrine therapy in various disease settings (neoadjuvant, adjuvant, metastatic). we systematically reviewed the scientific literature for prospective and retrospective studies assessing the efficacy of ais compared with other endocrine therapy in various disease settings (neoadjuvant, adjuvant, metastatic). after ais were demonstrated to be superior to tamoxifen in postmenopausal patients, some studies began to consider those agents in premenopausal patients to determine whether ais combined with a lhrh analog could better reduce the risk of recurrence. in the phase iii soft trial, premenopausal women with early bca were randomized to receive 5 years of adjuvant treatment with exemestane plus ovarian suppression, with tamoxifen plus ovarian suppression, or with tamoxifen alone; ovarian suppression was obtained using triptorelin, bilateral oophorectomy, or ovarian irradiation. in 24 patients (67%), some clinical benefit was achieved (5% complete response, 31% partial response, 31% stable disease for 6 months or more), with a median time to progression of 12 months and a duration of clinical benefit of 24 months.
the phase ii study conducted by park et al.30 evaluated the efficacy of letrozole plus goserelin compared with letrozole alone as first-line hormonal therapy in premenopausal and postmenopausal patients with metastatic bca. yao et al.31 investigated letrozole plus goserelin in both the first- and second-line treatment of premenopausal patients with metastatic bca. in the past, the only treatment of choice was tamoxifen alone or in combination with a lhrh analog. a combined analysis of the data from those two trials demonstrated that, compared with tamoxifen plus ovarian suppression, adjuvant endocrine therapy with exemestane plus ovarian suppression in premenopausal patients with hr+ bca was associated with a significantly improved dfs and an extended disease-free interval and interval without distant recurrence. the study demonstrated a higher risk of local recurrence and metastasis in patients with a bmi exceeding 35, and treatment with anastrozole was associated with a higher risk of recurrence in women with a bmi exceeding 30. in contrast, the efficacy of tamoxifen was independent of bmi43. in recent years, several studies have indicated that ais combined with a gnrh analog are safe and effective in premenopausal patients with hr+ bca.
tamoxifen is a selective estrogen receptor modulator (serm) that can be used to treat both pre- and postmenopausal women with breast cancer. a few years ago, third-generation aromatase inhibitors (ais) were introduced as an alternative to tamoxifen or in sequence after tamoxifen, tamoxifen — tamoxifen (brand name: soltamox) prevents estrogen from stimulating growth of the breast cancer cells. tamoxifen has been, refusing hormone therapy for breast cancer premenopausal, tamoxifen alternatives 2021, tamoxifen alternatives 2021, tamoxifen vs aromatase inhibitor premenopausal, premenopausal breast cancer treatment.
doctors now prescribe these three aromatase inhibitors more often than they prescribe tamoxifen for women who’ve gone through menopause. a study has found that more than 18% of premenopausal women tamoxifen can be used to treat both premenopausal and postmenopausal women. premenopausal women with breast cancers that express the estrogen and/or progesterone receptor (er and/or pr-positive) will often be encouraged to take, tamoxifen premenopausal side effects, why aromatase inhibitors not used in premenopausal.
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