Superior Efficacy of Letrozole Versus Tamoxifen as First-Line Therapy for Postmenopausal Women With Advanced Breast Cancer: Results of a Phase III Study of the International Letrozole Breast Cancer Group

Abstract

Letrozole was significantly superior to tamoxifen in TTP, TTF, ORR, and clinical benefit rate. Our results support its use as first-line endocrine therapy in postmenopausal women with advanced breast cancer.

Gene expression of estrogen receptor, progesterone receptor and microtubule-associated protein Tau in high-risk early breast cancer: a quest for molecular predictors of treatment benefit in the context of a Hellenic Cooperative Oncology Group trial

“…However, in most studies the investigators actually intended to identify those kRT-PCR mRNA cutoff values that would provide the highest concordance with the IHC status of the target protein. On the contrary, we regarded IHC ER and PgR protein expression determination as the most widely used analytical assay, but not the gold standard, in view of its moderate predictive value for benefit from endocrine therapies, semiquantitative nature of results and inter-or intra-laboratory reporting variability [2,3,[8][9][10]. Using distributional studies of mRNA values and taking into account hormonal receptor protein staining as a gross template, we sought to study the predictive value and correlation of a more conservative threshold, the 25th percentile of mRNA values, in order not to miss an effect of low, but potentially biologically significant level of messenger RNA.…”

“…These women become disease-free following surgical resection of the tumor and may be candidates for adjuvant systemic therapy aiming at eradication of micrometastatic deposits [1]. Estrogen receptor (ER) protein expression, studied by means of immunohistochemical (IHC) staining, is the gold standard for the selection of patients who will be managed with hormonal therapy, though its predictive value for benefit from such treatment is modest (30-60%) [2,3]. Several clinicopathological parameters, including tumor size, grade, ER status, axillary nodal status, patient age, and Human Epidermal growth factor Receptor-type 2 (HER2) overexpression are taken into consideration in order to identify which patients are most likely to benefit from administration of adjuvant cytotoxic chemotherapy and which drugs should be used [4,5].…”

Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial

“…The HR for PFS seen in this 321 study (0·797) is similar to the improvement shown by third-generation AIs over Page 16 tamoxifen. [4][5][6][7][8] In addition to the primary endpoint results, pre-defined subgroup 323 analyses were performed. The test for heterogeneity was not statistically significant 324 across all the subgroups although it was noted that potential enhanced treatment 325 effects with fulvestrant vs anastrozole were seen in some subgroups, including 326 patients with non-visceral disease compared with visceral disease.…”

Comparing the cost of adjuvant anastrozole with the benefits of managing less patients with relapsed breast cancer

“…The median overall survival for the patients relapsing at our institution (40.7 months), was higher than the 10-20 months Months since relapse Proportion of patients surviving reported with first-line metastatic studies in the UK and Europe evaluating metastatic chemotherapy regimens [18,19], but it was fairly comparable with the 20-30 months reported within first-line metastatic aromatase versus tamoxifen studies [9,20]. Although the median figure of £31,403 (Table 4) for treating a relapse is higher than previous UK estimates, the data is more recent and included the 30% of the community cost not previously collected.…”

“…Health economic analyses of anastrozole have been conducted in the past [6], but all estimate the cost of a relapse using predictive modelling, questionnaires or interviews with clinicians [2,3,[7][8][9]]. An independent United Kingdom (UK) trial, now 6 years old, estimated hospital costs of relapsed breast cancer by sending questionnaires to UK oncologists, and estimated a cost of £12,500 per patient [10,11].…”