S P Corona1, G Roviello2, C Strina3, M Milani3, S Madaro3, D Zanoni3, G Allevi3, S Aguggini3, M R Cappelletti3, M Francaviglia3, C Azzini3, A Cocconi3, M Sirico3, M Bortul4, F Zanconati4, F Giudici4, P Rosellini5, F Meani6, O Pagani6, D Generali7. 1. Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy. Electronic address: sil.corona@hotmail.it. 2. Department of Health Sciences, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. 3. U.O. Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, Azienda Socio-Sanitaria Territoriale di Cremona, Viale Concordia 1, 26100, Cremona, Italy. 4. Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy. 5. Unit of Medical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci - Policlinico "Le Scotte" 53100, Siena, Italy. 6. Centro di Senologia della Svizzera Italiana (CSSI), Ospedale Regionale di Lugano, CH-6962, Viganello, Switzerland. 7. Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy; U.O. Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, Azienda Socio-Sanitaria Territoriale di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
Abstract
BACKGROUND: Endocrine treatment with Tamoxifen and aromatase inhibitors (AIs) is a staple in the management of hormone receptor positive breast cancer (HR + BC). It has become clear that HR + BC carries a consistent risk of relapse up to 15 years post-diagnosis. While increasing evidence supports the use of extended adjuvant Tamoxifen over 5 years, controversial data are available on the optimal duration of extended AIs adjuvant treatment. We performed a meta-analysis to assess the real impact of extended adjuvant therapy with AIs on disease-free survival (DFS). METHODS: A literature-based meta-analysis of randomized controlled trials (RCTs) was undertaken. Relevant publications from PubMed, the Cochrane Library, and abstracts from American Society of Clinical Oncology (ASCO) and San Antonio Breast Cancer (SABCS) symposia were searched. Primary and secondary endpoints were Disease Free Survival (DFS) and overall survival (OS) respectively. A subgroup analysis was also performed to elucidate the impact of nodal involvement. RESULTS: The pooled analysis revealed a significant increase in DFS in the extended AIs group (hazard ratio (HR): 0.78, 95% CI: 0.68-0.90; P = 0.0006). The subgroup analysis according to nodal status showed a greater DFS benefit with extended AIs in patients with positive nodes (HR = 0.67 versus 0.80). Our analysis also demonstrated no improvement in OS with extended AIs (HR = 0.99, 95%CI: 0.87-1.12; P = 0.84). CONCLUSION: This work confirmed the efficacy of extended adjuvant treatment with AIs for HR + early breast cancer, with a 22% increase in DFS, but no impact on OS. Greater efficacy was observed in women with positive nodal status.
BACKGROUND: Endocrine treatment with Tamoxifen and aromatase inhibitors (AIs) is a staple in the management of hormone receptor positive breast cancer (HR + BC). It has become clear that HR + BC carries a consistent risk of relapse up to 15 years post-diagnosis. While increasing evidence supports the use of extended adjuvant Tamoxifen over 5 years, controversial data are available on the optimal duration of extended AIs adjuvant treatment. We performed a meta-analysis to assess the real impact of extended adjuvant therapy with AIs on disease-free survival (DFS). METHODS: A literature-based meta-analysis of randomized controlled trials (RCTs) was undertaken. Relevant publications from PubMed, the Cochrane Library, and abstracts from American Society of Clinical Oncology (ASCO) and San Antonio Breast Cancer (SABCS) symposia were searched. Primary and secondary endpoints were Disease Free Survival (DFS) and overall survival (OS) respectively. A subgroup analysis was also performed to elucidate the impact of nodal involvement. RESULTS: The pooled analysis revealed a significant increase in DFS in the extended AIs group (hazard ratio (HR): 0.78, 95% CI: 0.68-0.90; P = 0.0006). The subgroup analysis according to nodal status showed a greater DFS benefit with extended AIs in patients with positive nodes (HR = 0.67 versus 0.80). Our analysis also demonstrated no improvement in OS with extended AIs (HR = 0.99, 95%CI: 0.87-1.12; P = 0.84). CONCLUSION: This work confirmed the efficacy of extended adjuvant treatment with AIs for HR + early breast cancer, with a 22% increase in DFS, but no impact on OS. Greater efficacy was observed in women with positive nodal status.
Authors: Inés Gómez-Acebo; Trinidad Dierssen-Sotos; Camilo Palazuelos-Calderón; Beatriz Pérez-Gómez; Pilar Amiano; Marcela Guevara; Antonio J Molina; Laia Domingo; María Fernández-Ortiz; Victor Moreno; Juan Alguacil; Guillermo Fernández-Tardón; Josefa Ibáñez; Rafael Marcos-Gragera; Marian Diaz-Santos; M Henar Alonso; Jessica Alonso-Molero; Gemma Castaño-Vinyals; Andrés García Palomo; Eva Ardanaz; Amaia Molinuevo; Nuria Aragonés; Manolis Kogevinas; Marina Pollán; Javier Llorca Journal: Breast Cancer Res Treat Date: 2020-04-30 Impact factor: 4.872