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BREAST CANCER
When used first, letrozole may work better than tamoxifen.
THE QUESTION: A class of drugs called aromatase inhibitors has been shown to help women whose breast cancer does not respond to tamoxifen, the standard hormone treatment for cancers that require estrogen to grow. Might such a drug, which prevents estrogen from being produced, also prove beneficial if taken initially?
THIS STUDY randomly assigned 8,010 post-menopausal women with the type of early-stage breast cancer known as hormone-receptor-positive to take tamoxifen or letrozole (Femara) daily. After a little more than two years, cancer had recurred 19 percent less often among women taking letrozole than among those taking tamoxifen; the chance of its spreading to distant sites in the body was 27 percent less for the letrozole group. The study estimated that 84 percent of the letrozole group and 81 percent of the tamoxifen group would remain cancer-free for at least five years. Fractures, high cholesterol and serious heart problems were more common among women taking letrozole; blood clots, vaginal bleeding and endometrial cancer occurred more often in the tamoxifen group.
WHO MAY BE AFFECTED BY THESE FINDINGS? Women with hormone-receptor-positive breast cancer; 50 to 70 percent of all breast cancers are this type.
CAVEATS: A longer study would be needed to determine whether letrozole would continue to affect the relapse rate after treatment had stopped, as tamoxifen has been shown to do. The study was funded by Novartis, which makes Femara; company employees were members of a committee that reviewed the article, and seven of 14 primary authors had received consulting fees from Novartis.
FIND THIS STUDY Dec. 29 issue of the New England Journal of Medicine; abstract available online at www.nejm.org .
When used first, letrozole may work better than tamoxifen.
THE QUESTION: A class of drugs called aromatase inhibitors has been shown to help women whose breast cancer does not respond to tamoxifen, the standard hormone treatment for cancers that require estrogen to grow. Might such a drug, which prevents estrogen from being produced, also prove beneficial if taken initially?
THIS STUDY randomly assigned 8,010 post-menopausal women with the type of early-stage breast cancer known as hormone-receptor-positive to take tamoxifen or letrozole (Femara) daily. After a little more than two years, cancer had recurred 19 percent less often among women taking letrozole than among those taking tamoxifen; the chance of its spreading to distant sites in the body was 27 percent less for the letrozole group. The study estimated that 84 percent of the letrozole group and 81 percent of the tamoxifen group would remain cancer-free for at least five years. Fractures, high cholesterol and serious heart problems were more common among women taking letrozole; blood clots, vaginal bleeding and endometrial cancer occurred more often in the tamoxifen group.
WHO MAY BE AFFECTED BY THESE FINDINGS? Women with hormone-receptor-positive breast cancer; 50 to 70 percent of all breast cancers are this type.
CAVEATS: A longer study would be needed to determine whether letrozole would continue to affect the relapse rate after treatment had stopped, as tamoxifen has been shown to do. The study was funded by Novartis, which makes Femara; company employees were members of a committee that reviewed the article, and seven of 14 primary authors had received consulting fees from Novartis.
FIND THIS STUDY Dec. 29 issue of the New England Journal of Medicine; abstract available online at www.nejm.org .
