23 december 2013: lees ook dit artikel: dasatinib-toegevoegd-aan-femara-letrozole-verdubbelt-ziektevrije-tijd-voor-patienten-met-hormoongevoelige-her2-neu-negatieve-uitgezaaide-borstkanker

27 juni 2012: er is zoveel gepubliceerd over hormoonremmers, aromaseremmers enz. voor de behandeling van borstkanker dat het onmogelijk is dat allemaal hier te publiceren. Als u naar oncoline-borstkanker gaat dan staat daar in de NABON nota in ieder geval wat de huidige richtljnen zijn voor borstkanker, maar ook dat is geschreven in medische taal en zeer uitgebreid.

Dit artikel: Construction of a database for the evaluation and the clinical management of patients with breast cancer treated with antiestrogens and/or aromatase inhibitors 

geeft een Engelstalig overzicht van hormoontherapie en aromaseremmers bij borstkanker. Hier het abstract van dit artikel. Onderaan hebben we een referentielijst toegevoegd behorend bij dit artikel. 


SOD Malattie del Metabolismo Minerale ed Osseo, AOU Careggi, Florence, Italy.


Breast cancer, mostly exhibiting an hormone-dependent pathogenesis, is a commonly diagnosed cancer in females.It is well known that sex steroids favor the process of carcinogenesis of breast tissue and anti-hormonal therapy of breast cancer aims to decrease the action of estrogens on this tissue. For this purpose, two different compounds are prevalently used: the Selective Estrogen Receptor Modulators, preventing the cancer cell to interact with estrogens, and Aromatase Inhibitors, inhibiting the tissue conversion of androgens into estrogens. Unfortunately, latter treatments negatively impact on bone mass leading to the onset of osteoporosis. For this purpose, we propose to build a database to afford, to store and analyze information about the effects of treatment with Selective Estrogen Receptor Modulators and/or Aromatase Inhibitors on bone metabolism in patients with breast cancer referred to Our Center. We will focus on the possibility of intervening to reduce the negative effects on bone both by the identification of modifiable risk factors and administration of specific therapies, in order to create a therapeutic, diagnostic standard workup for these diseases.

[PubMed - in process]

8 augustus 2005: Bron: Lancet 2005;366:431-433,455-462. en J Clin Oncol. 2005 Aug 1;23(22):5138-47. Epub 2005 Jul 11 en Medscape

Vrouwen met vroeg gediagnosteerde borstkanker en daaraan geholpen en die na twee jaar overstappen van Tamoxifen naar Arimidex verminderen daarmee significant de kans op een recidief blijkt uit twee grote gerandomiseerde studies gepubliceerd in the Lancet en Clinical Oncology. In 1 studie gepubliceerd in The Lancet werden twee groepen gevormd van ca. 1600 vrouwen en in de groep die alleen Tamoxifen gebruikte waren er na een follow-up van 28 maanden 67 vrouwen met een recidief uit de Arimidex groep en 110 vrouiwen met een recidief in de Tamoxifen groep (hazard ratio 0.60 na 3 jaar, p = 0.0009). Het absolute verschil tussen de Tamoxifen groep en Arimidex groep op een drie jaar ziektevrije tijd was slechts 3,1 % maar dit cijfer is misleidend aldus de onderzoekers omdat jarenlange ziektevrije overlevingscijfers sowieso bij deze groep vrouwen erg hoog ligt. Bij de Arimidex groep deden zich wel meer botbreuken voor dan in de Tamoxifen groep , maar is naar wij weten te voorkomen met bv. Zometa of andere botversterkende middelen. De resultaten zijn onafhankelijk van tumorstadium, hormoongevoeligheid en al of niet klieruitzaaiingen. De studie uit Clinical Oncology bevestigt de studieresultaten uit The Lancet. Achtereenvolgens het studie abstract uit Clinical Oncology, een studie abstract uit The Lancet van januari 2005 met zelfde resultaten,

J Clin Oncol. 2005 Aug 1;23(22):5138-47. Epub 2005 Jul 11.

Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the italian tamoxifen anastrozole trial.

Boccardo F, Rubagotti A, Puntoni M, Guglielmini P, Amoroso D, Fini A, Paladini G, Mesiti M, Romeo D, Rinaldini M, Scali S, Porpiglia M, Benedetto C, Restuccia N, Buzzi F, Franchi R, Massidda B, Distante V, Amadori D, Sismondi P.

National Cancer Research Institute and the University of Genoa, Italy, Largo R. Benzi 10, 16132 Genoa, Italy; e-mail: f.boccardo@unige.it.

PURPOSE Tamoxifen, which is actually the gold standard adjuvant treatment in estrogen receptor-positive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy because of the development of resistance. Therefore new approaches are required.

PATIENTS AND METHODS We conducted a prospective randomized trial to test the efficacy of switching postmenopausal patients who were already receiving tamoxifen to the aromatase inhibitor anastrozole. After 2 to 3 years of tamoxifen treatment, patients were randomly assigned either to receive anastrozole 1 mg/d or to continue receiving tamoxifen 20 mg/d, for a total duration of treatment of 5 years. Disease-free survival was the primary end point. Event-free survival, overall survival, and safety were secondary end points. Results Four hundred forty-eight patients were enrolled. All women had node-positive, estrogen receptor-positive tumors. At a median follow-up time of 36 months, 45 events had been reported in the tamoxifen group compared with 17 events in the anastrozole group (P = .0002). Disease-free and local recurrence-free survival were also significantly longer in the anastrozole group (hazard ratio = 0.35; 95% CI, 0.18 to 0.68; P = .001 and HR = 0.15; 95% CI, 0.03 to 0.65; P = .003, respectively). Overall, more adverse events were recorded in the anastrozole group compared with the tamoxifen group (203 v 150, respectively; P = .04). However, more events were life threatening or required hospitalization in the tamoxifen group than in the anastrozole group (33 of 150 events v 28 of 203 events, P = .04)

CONCLUSION Switching to anastrozole after the first 2 to 3 years of treatment is well tolerated and significantly improves event-free and recurrence-free survival in postmenopausal patients with early breast cancer.

PMID: 16009955 [PubMed - in process]

Lancet. 2005 Jan 1-7;365(9453):60-2.

Comment in:
Lancet. 2005 Apr 2-8;365(9466):1225; author reply 1225-6.
Lancet. 2005 Apr 2-8;365(9466):1225; author reply 1225-6.

Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer.

Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS; ATAC Trialists' Group.

Christie Hospital, Manchester, UK. anthony.howell@christie-tr.nwest.nhs.uk

The standard adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer is 5 years of tamoxifen, but recurrences and side-effects restrict its usefulness. The aromatase inhibitor anastrozole was compared with tamoxifen for 5 years in 9366 postmenopausal women with localised breast cancer. After a median follow-up of 68 months, anastrozole significantly prolonged disease-free survival (575 events with anastrozole vs 651 with tamoxifen, hazard ratio 0.87, 95% CI 0.78-0.97, p=0.01) and time-to-recurrence (402 vs 498, 0.79, 0.70-0.90, p=0.0005), and significantly reduced distant metastases (324 vs 375, 0.86, 0.74-0.99, p=0.04) and contralateral breast cancers (35 vs 59, 42% reduction, 12-62, p=0.01). Almost all patients have completed their scheduled treatment, and fewer withdrawals occurred with anastrozole than with tamoxifen. Anastrozole was also associated with fewer side-effects than tamoxifen, especially gynaecological problems and vascular events, but arthralgia and fractures were increased. Anastrozole should be the preferred initial treatment for postmenopausal women with localised hormone-receptor-positive breast cancer.

PMID: 15639680 [PubMed - indexed for MEDLINE]

Bron: Medscape:

Switch From Tamoxifen to Anastrozole Benefits Women With Early Breast Cancer

NEW YORK (Reuters Health) Aug 04 - Women with early breast cancer who have been taking tamoxifen for 2 years significantly reduce their risk of disease recurrence when they are switched to anastrozole for the next 3 years, according to analysis of data from two large prospective trials.

Other research has demonstrated anastrozole's improved efficacy and tolerability compared with tamoxifen as initial adjuvant therapy, Dr. Raimund Jakesz and colleagues note in their report, published in the August 6th issue of The Lancet. Whether patients on tamoxifen would benefit from replacing it with anastrozole after 2 years of treatment has not been established.

To explore this issue, Dr. Jakesz, from Vienna Medical University in Austria, and colleagues there and at the University of Frankfurt in Germany examined results of two trials in which postmenopausal women with resected hormone-sensitive early breast cancer had completed 2 years treatment with tamoxifen 20 to 30 mg daily.

The patients were randomly assigned to switch to anastrozole 1mg/day for 3 years (n = 1618) or to remain on tamoxifen (n = 1606). Events that were documented were local or distant metastasis or contralateral breast cancer.

During median follow-up of 28 months, 67 events were noted in the anastrozole group and 110 in the tamoxifen group (hazard ratio 0.60 at 3 years, p = 0.0009). The absolute benefit in event-free survival at 3 years was 3.1%

The advantages of swapping adjuvant treatment were not dependent on tumor grade, nodal status, age, or receptor positivity.

Anastrozole was associated with significantly more fractures (34 versus 16, p = 0.015) and fewer thromboses (3 versus 12, p = 0.034). There was also a trend towards fewer emboli and endometrial cancers in the anastrozole group.

"This combined analysis confirms that postmenopausal women who receive tamoxifen as adjuvant therapy should be switched to anastrozole after 2 years of treatment," Dr. Jakesz and his associates conclude.

The apparently small 3% absolute reduction in recurrence "is potentially misleading because of the generally good prognosis and low rates of relapse of most patients in these trials," Dr. Anthony Howell, from Christie Hospital NHS Trust in Manchester, UK, maintains in a related commentary.

"This does mean," he adds, "that some patients are unnecessarily treated with adjuvant endocrine therapy, indicating we need improved markers of the presence of important micrometastatic spread."

Lancet 2005;366:431-433,455-462

Bron: Public Relations van Astrazeneca:

Astrazenca stuurde ons een persbericht waarin o.a. volledige omschrijving van werking en toedieningsprocedure en eventuele bijwerkingen van Arimidex dat als volgt begint:

Onderzoek: veranderen van medicijn verkleint kans terugkeer borstkanker

Zoetermeer 5 augustus 2005 - De kans op terugkeer van borstkanker kan verkleind worden door een verandering van geneesmiddel. Vandaag publiceert het toonaangevende tijdschrift The Lancet (www.thelancet.com) dit goede nieuws. Dit is van groot belang voor de duizenden vrouwen in Nederland die tamoxifen gebruiken als behandeling voor hun borstkanker. Hieruit blijkt dat post-menopausale vrouwen die tamoxifen gebruiken minder kans hebben op de terugkeer van de borstkanker als ze na 2 jaar tamoxifen de therapie veranderen naar de aromataseremmer anastrozol (Arimidex®). De publicatie betreft een combinatie van gegevens van een Duitse (ARNO) en een Oostenrijkse (ABCSG) studie. De verandering van tamoxifen naar anastrozol resulteerde in een 40 % verlaging van het risico op de terugkeer van borstkanker, na een (mediane) follow-up van 28 maanden. Tevens resulteerde het in een 39% verlaging van het risico op uitzaaiingen.

Database for the evaluation and the clinical management of patients with breast cancer treated with antiestrogens and/or aromatase inhibitors


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