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Old 06-20-2003, 01:28 AM   #1
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On June 12 2003 the New England Journal of Medicine published an excellent overview article relating to "Aromatase Inhibitors in Breast Cancer." In my opinion the article represents the best medical summary that I have seen to date in regard to Nolvadex (Tamoxifen) Arimidex (anastrozole) and Femara (Letrozole).

Unfortunately a free copy of the full text article is not available. A copy can be made for a cost of (U.S.)$10.00. If you are a women that is postmenopausal HER-2 positive and Estrogen positive I would strongly recommend that you read this article.

I have provided below a cross-link to the NEJM article excerpt and accompanying a table of contents.

The conclusion of the NEJM article is as follows:

The third generation aromatase inhibitors are a new development in the endocrine treatment of estrogen receptor-positive breast cancer in postmenopausal women. In the treatment of advanced disease letrozole [Femara] is convincingly better than tamoxifen and anastrozole [Arimidex] is at least as good. In early breast cancer adjuvant therapy with anastrozole [Arimidex] already appears to be superior to adjuvant therapy with tamoxifen in reducing the risk of relaspe and letrozole [Femara] appears to be more effective than tamoxifen as preoperative therapy. It is possible that third-generation aromatase inhibitors will have a role in chemoprevention [i.e. lower estrogen levels prior to the onset of breast cancer] but the long-term effects of profound estrogen suppression in postmenopausal women are unknown and careful monitoring for bone demineralization [i.e. bone loss] and other potential problems is essential as their role evolves.

Recent preliminary and mid-level clinical study findings at the 2001 2002 San Antonio Breast Cancer Symposiums and the 2001 Annual Meeting of the American Society of Clinical Oncologists (ASCO)seem to support the conclusion of the NEJM article as follows:

The ATAC study was initiated to determine whether Arimidex was more effective than Tamoxifen. After a median of 33 months of follow-up Arimidex alone prolonged disease-free survival better than tamoxifen. See 2001 San Antonio Breast Cancer Symposium Abstract No. 8. Follow-up studies extending the ATAC results to 47 months are approximately the same as those reported at the 2001 SABCS. See 2002 San Antonio Breast Cancer Symposium Abstract Nos. 13 632 & 633.

J Clin Oncol. 2001:19:2596-606 (Letrozole has shown superior efficacy over tamoxifen in first-line treatment of postmenopausal women with advanced breast cancer and reduced risk of progression by 30% compared with tamoxifen).

‚ÄúSerum HER-2/neu and Response to the Aromatase Inhibitor Letrozole Versus Tamoxifen ‚Ä? Lipton A et. al. San Antonio Breast Cancer Symposium 2001 Abstract No. 6 (Letrozole had a better ‚Äútime to progression‚Ä? of disease than Tamoxifen).

‚ÄúLetrozole (Femara) is More Effective Anti-Proliferative Agent Than Tamoxifen Irrespective of ErbB1 [HER-1] and/or ErbB2 [HER-2] Positive Status: Evidence From a Phase III Randomized Trial of Neoadjuvant Endocrine Therapy For Postmenopausal Women With Estrogen Receptor Positive Primary Breast Cancer ‚Ä? Ellis MJ (Duke University) et. al. San Antonio Breast Cancer Symposium 2001 Abstract No. 10 (Letrozole reduces cell proliferation more than Tamoxifen offering an explanation for the superior clinical efficacy of Letrozole. Tamoxifen did not significantly reduce the proliferation of ErbB+ ER+ breast cancer accounting for the marked advantage of Letrozole for this breast cancer subtype).

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