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Adjuvant Hormone Therapy for Breast Cancer

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Breast Diseases

Abstract

Estrogen plays a key role in the development of breast cancer, and its blockage is the basis of hormone therapy.

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  1. Brufsky A, Bosseman LD, Coradonna R, Haley BB, Jones CM, Moore HC, et al. Zoledronic acid effectively prevents aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozol: Z-FAST Study 36-month follow-up results. Clin Breast Cancer. 2009;9(2):77–85. Patients receiving adjuvant letrozole were randomized (301 in each group) to receive zoledronic acid early or late. After 12 months, bone densitometry showed a 4.4% higher lumbar spine density and, in the hip, 3.3% higher in the early treatment group. Early use of zoledronic acid prevents loss of bone mass in postmenopausal women using adjuvant letrozole.

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  2. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of estrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16. Available from: https://doi.org/10.1016/S0140-6736(12)61963-1. Patients receiving adjuvant tamoxifen were randomized to discontinue treatment after 5 years or completing 10 years regardless of their age or menopausal status. Treatment for 10 years was associated with a significant reduction in the risk of tumor recurrence and death, and was associated with a small increase in the risk of pulmonary embolism, cardiac ischemia and endometrial neoplasia.

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  3. Goss PE, Ingle JN, Printchard KI, Robert NJ, et al. Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med. 2016;375:209–19. The MA.17R study evaluated the impact of extending the use of letrozole for an additional 5 years versus placebo. 1918 patients were included and those who received extended adjuvant showed increased disease-free survival with a 34% reduction in recurrence (HR 0.66 and p 0.01). The extent use of letrozole was related to a decrease in the incidence of new contralateral lesion and modest impact on distant relapse.

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  4. Jonat W, Gnant M, Boccardo F, Kaufmann M, Rubagotti A, Zuna I, et al. Effectiveness of switching from adjuvant tamoxifen to anastrozole in postmenopausal women with hormone-sensitive early-stage breast cancer: a meta-analysis. Lancet Oncol. 2006;7(12):991–6. A meta-analysis of three clinical studies: ABCSG8, ARNO 95 and ITA with the aim of evaluating whether sequential treatment with anastrozole after 2–3 years of tamoxifen would be more effective than the continuation of tamoxifen for 5 years. Sequential treatment showed an increase in progression-free survival (HR 0.59, CI 0.48–0.74), distance free survival (HR 0.61, IC: 0.45–0.83) and overall survival (HR 0.71, CI 0.52–0.98).

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Shimada, A.K., Alessi, J.V.M., Zucchetti, B., Katz, A. (2019). Adjuvant Hormone Therapy for Breast Cancer. In: Novita, G., Frasson, A., Millen, E., Zerwes, F., Cavalcante, F. (eds) Breast Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-13636-9_58

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  • DOI: https://doi.org/10.1007/978-3-030-13636-9_58

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-13635-2

  • Online ISBN: 978-3-030-13636-9

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