Oncology

Clinical Study

Eligibility, Compliance and Persistence of Sequential Therapy with Aromatase Inhibitors following 2–3 Years of Tamoxifen in Endocrine Adjuvant Breast Cancer Therapy

Kilic N.a–c · Myrick M.E.a · Schmid S.M.a, b · Gueth U.a, b, d

Author affiliations

aDepartment of Gynecology and Obstetrics, bBreast Center and cDepartment of Oncology, University Hospital Basel, Basel, and dDepartment of Gynecology and Obstetrics, Cantonal Hospital Winterthur, Winterthur, Switzerland

Related Articles for ""

Oncology 2011;81:151–157

Log in to MyKarger to check if you already have access to this content.


Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!


If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.

Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select
* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: June 15, 2011
Accepted: June 15, 2011
Published online: October 25, 2011
Issue release date: December 2011

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 0030-2414 (Print)
eISSN: 1423-0232 (Online)

For additional information: https://www.karger.com/OCL

Abstract

Objective: This study evaluated the eligibility, compliance and persistence of sequential therapy, i.e. a switch to an aromatase inhibitor (AI) following 2–3 years of tamoxifen, in adjuvant endocrine breast cancer (BC) treatment. Methods: Data concerning 388 BC patients (age ≤70 years) who started endocrine adjuvant therapy between 1998 and 2008 were analyzed. Results: From the 263 patients who started therapy with tamoxifen, 167 (63.5%) were eligible for a sequential therapy. Fifty-nine patients (35.3%) were offered a switch by their physicians; women who had their follow-up at oncological units received the offer more often when compared to those treated by general practitioners (p < 0.001). Out of these 59 patients, 50 followed the proposal (compliance 84.7%). Of those who agreed to a sequential therapy, 2 (4%) were non-persistent to endocrine therapy; in 9 cases (18.0%), a re-switch to tamoxifen was done due to AI-related adverse side effects. Conclusions: Only a minority of the patients who started an endocrine adjuvant BC therapy was eligible for sequential therapy. Patients who underwent a switch had a high rate of persistence. Efforts should be made to make sure that all physicians, above all general practitioners, who are involved in the treatment of BC patients, are provided with current therapy guidelines.

© 2011 S. Karger AG, Basel




Related Articles:


References

  1. Coates AS, Keshaviah A, Thurlimann B, et al: Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol 2007;25:486–492.
  2. Coombes RC, Kilburn LS, Snowdon CF, et al: Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 2007;369:559–570.
  3. Forbes JF, Cuzick J, Buzdar A, et al: Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008;9:45–53.
  4. Jonat W, Gnant M, Boccardo F, 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;7:991–996.
  5. Mouridsen H, Giobbie-Hurder A, Goldhirsch A, et al: Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med 2009;361:766–776.
  6. van de Velde CJ, Rea D, Seynaeve C, et al: Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial. Lancet 2011;377:321–331.
  7. Dowsett M, Cuzick J, Ingle J, et al: Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 2010;28:509–518.
  8. Josefsson ML, Leinster SJ: Aromatase inhibitors versus tamoxifen as adjuvant hormonal therapy for oestrogen sensitive early breast cancer in post-menopausal women: meta-analyses of monotherapy, sequenced therapy and extended therapy. Breast 2010;19:76–83.
  9. van de Velde CJ, Verma S, van Nes JG, et al: Switching from tamoxifen to aromatase inhibitors for adjuvant endocrine therapy in postmenopausal patients with early breast cancer. Cancer Treat Rev 2010;36:54–62.
  10. Chlebowski RT, Geller ML: Adherence to endocrine therapy for breast cancer. Oncology 2006;71:1–9.
  11. Hadji P: Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy. Crit Rev Oncol Hematol 2010;73:156–166.
  12. Edge S, Byrd D, Compton C, et al: AJCC Cancer Staging Manual, ed. 7. New York, Springer, 2009.
  13. Sobin L, Gospodarowicz M, Wittekind C (eds): UICC: TNM Classification of Malignant Tumors, ed. 7. Oxford, Wiley-Blackwell, 2009.
  14. Goldhirsch A, Wood WC, Gelber RD, et al: Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 2007;18:1133–1144.
  15. Andrade SE, Kahler KH, Frech F, Chan KA: Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 2006;15:565–574, discussion 575–577.
  16. Barron TI, Connolly R, Bennett K, et al: Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 2007;109:832–839.
  17. Osterberg L, Blaschke T: Adherence to medication. N Engl J Med 2005;353:487–497.
  18. Guth U, Huang DJ, Schotzau A, et al: Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer. Br J Cancer 2008;99:428–433.
  19. Burstein HJ, Griggs JJ, Prestrud AA, Temin S: American Society of Clinical Oncology clinical practice guideline update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Oncol Pract 2010;6:243–246.
  20. Goldhirsch A, Ingle JN, Gelber RD, et al: Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol 2009;20:1319–1329.
  21. Hong S, Didwania A, Olopade O, Ganschow P: The expanding use of third-generation aromatase inhibitors: what the general internist needs to know. J Gen Intern Med 2009;24(suppl 2):S383–S388.
  22. Boccardo F, Rubagotti A, Puntoni M, et al: Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the Italian Tamoxifen Anastrozole Trial. J Clin Oncol 2005;23:5138–5147.
  23. Kaufmann M, Jonat W, Hilfrich J, et al: Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. J Clin Oncol 2007;25:2664–2670.

Article / Publication Details

First-Page Preview
Abstract of Clinical Study

Received: June 15, 2011
Accepted: June 15, 2011
Published online: October 25, 2011
Issue release date: December 2011

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 2

ISSN: 0030-2414 (Print)
eISSN: 1423-0232 (Online)

For additional information: https://www.karger.com/OCL


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
TOP