Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo : Meta-analyses on efficacy and adverse events based on randomized clinical trials

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Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo : Meta-analyses on efficacy and adverse events based on randomized clinical trials

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Publication Article, review peer-reviewed scientific
Title Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo : Meta-analyses on efficacy and adverse events based on randomized clinical trials
Author Rydén, Lisa ; Arnlind, Marianne Heibert ; Vitols, Sigurd ; Höistad, Malin ; Ahlgren, Johan
Date 2016
English abstract
Tamoxifen (TAM) and aromatase inhibitors (AI) are adjuvant therapy options for postmenopausal women with estrogen receptor positive (ER+) breast cancer. This systematic review of seven randomized controlled studies comparing TAM and AI, and one study comparing extended therapy with an AI with placebo after about 5 years of tamoxifen, aims to assess long-term clinical efficacy and adverse events. The literature review was performed according to the principles of the Cochrane Collaboration. The search included common databases up to 2013-01-14. Studies of high or moderate quality were used for grading of evidence. Revman (TM) software was utilized for meta-analyses of published data. Disease free survival (DFS) and overall survival (OS) were improved with AI monotherapy compared to TAM with high and moderate quality of evidence respectively. Sequenced therapy with AI -> TAM (or vice versa) improved DFS compared with TAM with moderate quality of evidence, but did not improve OS (low quality of evidence). However, if only studies on sequenced AI therapy with randomization before endocrine therapy were considered, no improvement of DFS could be found. Fractures are more frequently associated with AI whereas the risk of endometrial cancer and venous thromboembolism are higher with TAM. For cardiovascular events no difference was found between AI (mono-or sequenced therapy) and TAM, whereas sequenced therapy compared with AI had lower risk of cardiovascular events (moderate level of evidence). AIs are superior to TAM as adjuvant hormonal therapy for postmenopausal ER-positive breast cancer. TAM can be considered for individual patients due to the different toxicity profile compared with AI. Cardiovascular events related to AI treatment deserve further attention.
DOI https://doi.org/10.1016/j.breast.2016.01.006 (link to publisher's fulltext.)
Publisher Churchill Livingstone
Host/Issue Breast;
Volume 26
ISSN 0960-9776
Pages 106-114
Language eng (iso)
Subject Aromatase inhibitors
Tamoxifen
Early breast cancer
Randomized clinical trial
Systematic review
Adverse events
Medicine
Research Subject Categories::MEDICINE
Handle http://hdl.handle.net/2043/23050 Permalink to this page
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