Jae Hong Seo1, Yeul Hong Kim, Jun Suk Kim. 1. Division of Medical Oncology, Department of Internal Medicine, College of Medicine, Korea University Guro Hospital, 97 Gurodong-gil, Guro-ku, Seoul 152-703, South Korea. cancer@korea.ac.kr
Abstract
PURPOSE: Clinical trials have reported conflicting results as to whether pre-operative aromatase inhibitors (AIs) improve outcome over pre-operative tamoxifen in postmenopausal women with hormone receptor-positive breast cancer. METHODS: We performed a meta-analysis comparing primary and secondary end points of pre-operative AI and pre-operative tamoxifen. The event-based risk ratio (RR) with 95% confidence intervals (95% Cis) were derived, and a test of heterogeneity was applied. RESULTS: Four studies (1,160 patients) met the inclusion criteria for the analysis. Meta-analysis showed that pre-operative AI was more effective than pre-operative tamoxifen. Pooled results of clinical efficacy were as follows: clinical objective response rate (RR, 1.29; 95% CI, 1.14-1.47; P < 0.001), ultrasound objective response rate (RR, 1.29; 95% CI, 1.10-1.51; P = 0.002), and breast conserving surgery (BCS) rate (RR, 1.36; 95% CI, 1.16-1.59; P < 0.001). Hot flashes, nausea, and fatigue were not different between the pre-operative AI and pre-operative tamoxifen groups. Although headache was more frequent in the pre-operative AI group (P = 0.011), it was a manageable toxicity and was not clinically relevant. CONCLUSION: Pre-operative AI has better BCS rate than tamoxifen and in terms of toxicities, is not inferior to tamoxifen; therefore, we could suggest pre-operative AI instead of tamoxifen for those postmenopausal patients with hormone receptor positive breast cancer, not eligible for chemotherapy.
PURPOSE: Clinical trials have reported conflicting results as to whether pre-operative aromatase inhibitors (AIs) improve outcome over pre-operative tamoxifen in postmenopausal women with hormone receptor-positive breast cancer. METHODS: We performed a meta-analysis comparing primary and secondary end points of pre-operative AI and pre-operative tamoxifen. The event-based risk ratio (RR) with 95% confidence intervals (95% Cis) were derived, and a test of heterogeneity was applied. RESULTS: Four studies (1,160 patients) met the inclusion criteria for the analysis. Meta-analysis showed that pre-operative AI was more effective than pre-operative tamoxifen. Pooled results of clinical efficacy were as follows: clinical objective response rate (RR, 1.29; 95% CI, 1.14-1.47; P < 0.001), ultrasound objective response rate (RR, 1.29; 95% CI, 1.10-1.51; P = 0.002), and breast conserving surgery (BCS) rate (RR, 1.36; 95% CI, 1.16-1.59; P < 0.001). Hot flashes, nausea, and fatigue were not different between the pre-operative AI and pre-operative tamoxifen groups. Although headache was more frequent in the pre-operative AI group (P = 0.011), it was a manageable toxicity and was not clinically relevant. CONCLUSION: Pre-operative AI has better BCS rate than tamoxifen and in terms of toxicities, is not inferior to tamoxifen; therefore, we could suggest pre-operative AI instead of tamoxifen for those postmenopausal patients with hormone receptor positive breast cancer, not eligible for chemotherapy.
Authors: C J Wink; K Woensdregt; G A P Nieuwenhuijzen; M J C van der Sangen; S Hutschemaekers; J A Roukema; V C G Tjan-Heijnen; A C Voogd Journal: Ann Surg Oncol Date: 2011-10-27 Impact factor: 5.344
Authors: Iosief Abraha; Antonio Cherubini; Francesco Cozzolino; Rita De Florio; Maria Laura Luchetta; Joseph M Rimland; Ilenia Folletti; Mauro Marchesi; Antonella Germani; Massimiliano Orso; Paolo Eusebi; Alessandro Montedori Journal: BMJ Date: 2015-05-27
Authors: Romualdo Barroso-Sousa; Danilo D A Fonseca Reis Silva; Joao Victor Machado Alessi; Max Senna Mano Journal: Ecancermedicalscience Date: 2016-01-07