- Title
- Which patients benefit most from adjuvant aromatase inhibitors?: results using a composite measure of prognostic risk in the BIG 1-98 randomized trial
- Creator
- Viale, G.; Regan, M. M.; Lang, I.; Thürlimann, B.; Mouridsen, H.; Mauriac, L.; Gelber, R. D.; Price, K. N.; Goldhirsch, A.; Gusterson, B. A.; Coates, A. S.; Dell'Orto, P.; Mastropasqua, M. G.; Maiorano, E.; Rasmussen, B. B.; MacGrogan, G.; Forbes, J. F.; Paridaens, R. J.; Colleoni, M.
- Relation
- Annals of Oncology Vol. 22, Issue 10, p. 2201-2207
- Publisher Link
- http://dx.doi.org/10.1093/annonc/mdq738
- Publisher
- Oxford University Press
- Resource Type
- journal article
- Date
- 2011
- Description
- Background: On average, aromatase inhibitors are better than tamoxifen when used as initial or sequential therapy for postmenopausal women with endocrine-responsive early breast cancer. Because there may be contraindications to their use based on side-effects or cost, we investigated subgroups in which aromatase inhibitors may be more or less important. Patients and methods: Breast International Group 1-98 trial randomized 6182 women among four groups comparing letrozole and tamoxifen with sequences of each agent; 5177 (84%) had centrally confirmed estrogen receptor (ER) positivity. We assessed whether centrally determined ER, progesterone receptor (PgR), human epidermal growth factor receptor 2, and Ki-67 labeling index, alone or in combination with other prognostic features, predicted the magnitude of letrozole effectiveness compared with either sequence or tamoxifen monotherapy. Results: Individually, none of the markers significantly predicted differential treatment effects. Subpopulation treatment effect pattern plot analysis of a composite measure of prognostic risk revealed three patterns. Estimated 5-year disease-free survival for letrozole monotherapy, letrozole→tamoxifen, tamoxifen→letrozole, and tamoxifen monotherapy were 96%, 94%, 93%, and 94%, respectively, for patients at lowest risk; 90%, 91%, 93%, and 86%, respectively, for patients at intermediate risk; and 80%, 76%, 74%, and 69%, respectively, for patients at highest risk. Conclusion: A composite measure of risk informs treatment selection better than individual biomarkers and supports the choice of 5 years of letrozole for patients at highest risk for recurrence.
- Subject
- aromatase inhibitor; breast cancer; prognostic factor; tamoxifen
- Identifier
- http://hdl.handle.net/1959.13/1065143
- Identifier
- uon:17752
- Identifier
- ISSN:0923-7534
- Language
- eng
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