Late follow-up of a randomized trial of surgery plus tamoxifen <i>versus</i> tamoxifen alone in women aged over 70 years with operable breast cancer

Fennessy, Michelle M.; Bates, Tom; MacRae, K D; Riley, Diana; Houghton, J; Baum, Michael

doi:10.1002/bjs.4603

Cited by 164 publications

(104 citation statements)

References 19 publications

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“…None of the studies evaluated the oestrogen receptor status of the women they recruited. Four eligible trials addressing surgery plus endocrine therapy vs primary endocrine therapy were identified, of which three have reported outcome data (Willsher et al, 1997;Capasso et al, 2000;Mustacchi et al, 2003;Fennessey et al, 2004), although there is currently no data from one in a form that can be meta-analysed (Capasso et al, 2000). Not all trials identified provided adequate information on all outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of three trials was graded as A (Fentiman et al, 2003;Mustacchi et al, 2003;Fennessey et al, 2004) with the rest being graded as B (Gazet et al, 1994;Willsher et al, 1997;Kenny et al, 1998;Capasso et al, 2000). No potentially eligible study was excluded from the review.…”

Section: Resultsmentioning

confidence: 99%

“…Three trials (1076 women: Willsher et al, 1997; Mustacchi et al, 2003;Fennessey et al, 2004) reported data on OS which could be meta-analysed. There was a nonsignificant trend in favour of surgery plus endocrine therapy (HR 0.86, 95% CI 0.73 -1.00, P ¼ 0.06).…”

Section: Resultsmentioning

confidence: 99%

“…Adequate data were not available to evaluate the difference in distant metastasis-free interval. One study reported that both mastectomy and wide local excision significantly improved local control compared to primary endocrine therapy (Fennessey et al, 2004). One trial did not quantify adverse events, only reporting that one woman from the primary endocrine therapy arm had to drop out of the trial because of endocrine therapy-related adverse effects (Fennessey et al, 2004).…”

Section: Resultsmentioning

confidence: 99%

“…One study reported that both mastectomy and wide local excision significantly improved local control compared to primary endocrine therapy (Fennessey et al, 2004). One trial did not quantify adverse events, only reporting that one woman from the primary endocrine therapy arm had to drop out of the trial because of endocrine therapy-related adverse effects (Fennessey et al, 2004). In another, all patients in the surgery plus tamoxifen arm who had axillary clearance had paraesthesia on the ipsilateral arm and lateral thoracic wall.…”

Section: Resultsmentioning

confidence: 99%

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Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

2007

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The published literature comparing surgery, with or without adjuvant endocrine therapy, with endocrine therapy alone in older women with operable breast cancer was systematically reviewed.The design used is Cochrane review. Randomised controlled trials retrieved from the Cochrane Breast Cancer Group Specialised Register on 29 June 2005. Eligible studies recruited women aged 70 years or over with operable breast cancer, fit for surgery under general anaesthia. The studies compared surgery (either mastectomy or wide local excision, with or without endocrine therapy) to endocrine therapy alone. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Double data extraction and quality assessment were undertaken. Seven eligible trials were identified of which six had published time-to-event data. The quality of the allocation concealment was adequate in three studies and unclear in the remainder. In each case the endocrine therapy used was tamoxifen. When surgery alone was compared to endocrine therapy alone, there was no significant difference in OS (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.74 -1.30, P ¼ 0.9), but a significant difference in PFS (HR 0.55, 95% CI 0.39 -0.77, P ¼ 0.0006). When surgery with adjuvant endocrine therapy was compared to endocrine therapy alone, there was no significant difference in OS (HR 0.86, 95% CI 0.73 -1.00, P ¼ 0.06), but a significant difference in PFS (HR 0.65 (95% CI 0.53 -0.81, P ¼ 0.0001) for surgery plus endocrine therapy vs primary endocrine. The regimens have different side effect profiles with one study suggesting increased psychosocial morbidity at 3 months in the surgical arm, which resolves by 2 years. Primary endocrine therapy with tamoxifen is associated with inferior local disease control but noninferior survival to surgery for breast cancer in older women. Trials are needed to evaluate appropriate selection criteria for its use in terms of patient co-morbidity and quality of life. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for this population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

2007

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Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus)

Hind

Wyld

Beverley³

et al. 2006

Cochrane Database of Systematic Reviews

102

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Primary endocrine therapy should only be offered to women with oestrogen receptor (ER) positive tumours who are unfit for or who refuse surgery. In a cohort of women with significant co-morbid disease and ER-positive tumours it is possible that primary endocrine therapy may be a superior option to surgery. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for an infirm older population with ER-positive tumours.

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Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus)

Morgan

Wyld

Collins

et al. 2014

Cochrane Database of Systematic Reviews

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Background Several studies have evaluated the clinical effectiveness of endocrine therapy alone in women aged 70 years or over with operable breast cancer and who are fit for surgery. Objectives To systematically review the evidence for the clinical effectiveness of surgery (with or without adjuvant endocrine therapy) in comparison to primary endocrine therapy in the treatment of operable breast cancer in women aged 70 years and over, both in terms of local progression and mortality. Search methods We conducted an updated search of the Cochrane Breast Cancer Group's Specialised Register (27th March 2013) and new searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2013, Issue 3), MEDLINE, EMBASE, the World Health Organization's International Clinical Trials Registry Platform (apps.who.int/trialsearch/) and www.clinicaltrials.gov, using the search terms 'early breast cancer', 'endocrine therapy', 'psychosocial' or 'surgery'. Selection criteria Randomised trials comparing surgery, with or without adjuvant endocrine therapy, to primary endocrine therapy in the management of women aged 70 years or over with early breast cancer and who were fit for surgery. Data collection and analysis We assessed studies for eligibility and quality, and two review authors independently extracted data from published trials. We derived hazard ratios for time-to-event outcomes, where possible, and used a fixed-effect model for meta-analysis. We extracted toxicity and quality-of-life data, where present. Where outcome data were not available, we contacted trialists and requested unpublished data. 1 Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus) (Review)

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Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer

Abstract: Omission of primary surgery in unselected elderly women with operable breast cancer who were fit for the procedure resulted in an increased rate of progression, therapeutic intervention and mortality.

Cited by 164 publications

References 19 publications

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review

Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus)

Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus)

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