Extending the duration of endocrine treatment for early breast cancer: patient-level meta-analysis of 12 randomised trials of aromatase inhibitors in 22 031 postmenopausal women already treated with at least 5 years of endocrine therapy
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View abstract on PubMed
Summary
This summary is machine-generated.Five additional years of aromatase inhibitor treatment (AIT) significantly reduced breast cancer recurrence in postmenopausal women. This extended AIT improved outcomes, particularly for node-positive disease, but increased bone fracture risk.
Area Of Science
- Oncology
- Endocrinology
- Clinical Trials
Background
- Postmenopausal women with oestrogen receptor-positive early breast cancer benefit from adjuvant tamoxifen and aromatase inhibitor treatment (AIT).
- Effectiveness of extended AIT beyond 5 years in women recurrence-free after initial endocrine therapy requires assessment.
Purpose Of The Study
- To evaluate the efficacy of extending aromatase inhibitor treatment (AIT) in postmenopausal women with early breast cancer who have completed at least 5 years of endocrine therapy.
- To assess the impact of further AIT on recurrence, breast cancer mortality, and all-cause mortality.
Main Methods
- Individual patient data meta-analyses of 12 randomized trials involving 22,031 women.
- Comparison of subsequent AIT versus no further adjuvant therapy after at least 5 years of tamoxifen, AIT, or sequential tamoxifen-AIT.
- Intention-to-treat analyses for primary outcomes including invasive breast cancer recurrence, breast cancer mortality, and all-cause mortality.
Main Results
- Allocation to AIT significantly reduced recurrence rates by 27% (RR 0.73).
- Five further years of AIT reduced recurrence (RR 0.71) and distant recurrence (RR 0.73) in women with prior AIT, with greater absolute reduction in node-positive disease.
- Five further years of AIT increased 5-year bone fracture risk (RR 1.35) and showed substantial non-adherence to allocated treatment.
Conclusions
- Five additional years of AIT effectively reduced subsequent distant recurrence rates by approximately 25%, even with significant non-adherence.
- Extended AIT demonstrated a greater absolute benefit for node-positive disease.
- Longer follow-up is needed to definitively assess the impact of extended AIT on mortality.
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