26 december 2017: lees ook dit artikel:

https://kanker-actueel.nl/2-jaar-aromataseremmers-na-hormoontherapie-bij-borstkanker-geeft-dezelfde-overall-overleving-als-5-jaar-veel-borstkankerpatienten-worden-overbehandeld.html

Kijk hier voor specifieke studie informatie over Femara - Letrozole. Voor specifieke studie informatie over Arimidex hier

20 oktober 2015: Bron: The Lancet

In deze review studie gepubliceerd in The Lancet: Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials wordt het verschil in effectiviteit tussen tamoxifen en Arimidex gegeven.

Conclusie van deze studie:

Aromatase-remmers verminderen de kans op een recidief van borstkanker op 5 jaars meting met ongeveer 30% (verhoudingsgewijs) in vergelijking met tamoxifen, terwijl de behandelingen verschillen, daarna is het veschil minder. Na 5 jaar behandeling met een aromataseremmer vermindert de 10-jaars borstkanker sterftecijfers met ongeveer 15% vergeleken met 5 jaar tamoxifen, dus met ongeveer 40% (verhoudingsgewijs) vergeleken met geen hormoonbehandeling.

Hier enkele grafieken uit deze review studie. Abstract plus referentielijst staat onderaan artikel.

Figure 4

Recurrence reductions by time since surgery, combining data from different comparisons of aromatase inhibitor (AI) versus tamoxifen treatment as part of 5 years of endocrine therapy

Black squares show periods when the protocol specified that one group should receive an aromatase inhibitor and the other should receive tamoxifen; open squares show periods when the treatments should have been the same in both groups. *Aggregated totals are adjusted to avoid double counting of events in the four-way randomisation in BIG 1-98. AI=aromatase inhibitor. O–E=observed minus expected.

Large image of Figure 4.

Figure 2

5 years of aromatase inhibitor versus tamoxifen to years 2–3 then aromatase inhibitor to year 5

(A) Recurrence, (B) breast cancer mortality, (C) death without recurrence, and (D) death from any cause. RR=rate ratio. AI=aromatase inhibitor. O–E=observed minus expected. V=variance of O–E.

Large image of Figure 2.

Hier het abstract plus referentielijst:

Aromatase inhibitors reduce recurrence rates by about 30% (proportionately) compared with tamoxifen while treatments differ, but not thereafter. 5 years of an aromatase inhibitor reduces 10-year breast cancer mortality rates by about 15% compared with 5 years of tamoxifen, hence by about 40% (proportionately) compared with no endocrine treatment.

Lancet. 2015 Oct 3;386(10001):1341-1352. doi: 10.1016/S0140-6736(15)61074-1. Epub 2015 Jul 23.

Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials.

Early Breast Cancer Trialists' Collaborative Group (EBCTCG).

Abstract

BACKGROUND:

The optimal ways of using aromatase inhibitors or tamoxifen as endocrine treatment for early breast cancer remains uncertain.

METHODS:

We undertook meta-analyses of individual data on 31,920 postmenopausal women with oestrogen-receptor-positive early breast cancer in the randomised trials of 5 years of aromatase inhibitor versus 5 years of tamoxifen; of 5 years of aromatase inhibitor versus 2-3 years of tamoxifen then aromatase inhibitor to year 5; and of 2-3 years of tamoxifen then aromatase inhibitor to year 5 versus 5 years of tamoxifen. Primary outcomes were any recurrence of breast cancer, breast cancer mortality, death without recurrence, and all-cause mortality. Intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded aromatase inhibitor versus tamoxifen first-event rate ratios (RRs).

FINDINGS:

In the comparison of 5 years of aromatase inhibitor versus 5 years of tamoxifen, recurrence RRs favoured aromatase inhibitors significantly during years 0-1 (RR 0·64, 95% CI 0·52-0·78) and 2-4 (RR 0·80, 0·68-0·93), and non-significantly thereafter. 10-year breast cancer mortality was lower with aromatase inhibitors than tamoxifen (12·1% vs 14·2%; RR 0·85, 0·75-0·96; 2p=0·009). In the comparison of 5 years of aromatase inhibitor versus 2-3 years of tamoxifen then aromatase inhibitor to year 5, recurrence RRs favoured aromatase inhibitors significantly during years 0-1 (RR 0·74, 0·62-0·89) but not while both groups received aromatase inhibitors during years 2-4, or thereafter; overall in these trials, there were fewer recurrences with 5 years of aromatase inhibitors than with tamoxifen then aromatase inhibitors (RR 0·90, 0·81-0·99; 2p=0·045), though the breast cancer mortality reduction was not significant (RR 0·89, 0·78-1·03; 2p=0·11). In the comparison of 2-3 years of tamoxifen then aromatase inhibitor to year 5 versus 5 years of tamoxifen, recurrence RRs favoured aromatase inhibitors significantly during years 2-4 (RR 0·56, 0·46-0·67) but not subsequently, and 10-year breast cancer mortality was lower with switching to aromatase inhibitors than with remaining on tamoxifen (8·7% vs 10·1%; 2p=0·015). Aggregating all three types of comparison, recurrence RRs favoured aromatase inhibitors during periods when treatments differed (RR 0·70, 0·64-0·77), but not significantly thereafter (RR 0·93, 0·86-1·01; 2p=0·08). Breast cancer mortality was reduced both while treatments differed (RR 0·79, 0·67-0·92), and subsequently (RR 0·89, 0·81-0·99), and for all periods combined (RR 0·86, 0·80-0·94; 2p=0·0005). All-cause mortality was also reduced (RR 0·88, 0·82-0·94; 2p=0·0003). RRs differed little by age, body-mass index, stage, grade, progesterone receptor status, or HER2 status. There were fewer endometrial cancers with aromatase inhibitors than tamoxifen (10-year incidence 0·4% vs 1·2%; RR 0·33, 0·21-0·51) but more bone fractures (5-year risk 8·2% vs 5·5%; RR 1·42, 1·28-1·57); non-breast-cancer mortality was similar.

INTERPRETATION:

Aromatase inhibitors reduce recurrence rates by about 30% (proportionately) compared with tamoxifen while treatments differ, but not thereafter. 5 years of an aromatase inhibitor reduces 10-year breast cancer mortality rates by about 15% compared with 5 years of tamoxifen, hence by about 40% (proportionately) compared with no endocrine treatment.

FUNDING:

Cancer Research UK, Medical Research Council.

Copyright © 2015 Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Comment in

PMID:
26211827
DOI:
10.1016/S0140-6736(15)61074-1
[Indexed for MEDLINE]

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