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BMC Cancer. 2018 Oct 12;18(1):977. doi: 10.1186/s12885-018-4878-4.

Clinical outcomes comparison of 10 years versus 5 years of adjuvant endocrine therapy in patients with early breast cancer.

Author information

1
Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
2
Department of Biochemistry and Molecular Biology, Basic Medical College, Shanxi Medical University, Taiyuan, 030001, China.
3
Gastroenterology Department, JinCheng People's Hospital, Shanxi, 048000, China.
4
Biochemistry and Molecular Biology, Basic Medicine College, Shanxi Medical University, Taiyuan, 050001, China.
5
Statistical Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
6
Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
7
Molecular and Cellular Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, 77030, USA.
8
Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China. oncologistinbj@163.com.

Abstract

BACKGROUND:

Adjuvant endocrine therapy undoubtedly prolongs the time to recurrence for patients with hormone-positive early breast cancer. Extended endocrine therapy to 10 years or longer has been expected to bring a greater clinical advantage. However, the related research conclusions are controversial.

METHODS:

Tamoxifen (TAM), Aromatase Inhibitor (AI), Exemestane, letrozole (LET) and anastrozole were used as key words in the literature search. After the patients completed 5 years of adjuvant endocrine treatment, they were allocated to continue endocrine treatment for 5 years or receive placebo/observation for 5 years. Disease-free survival (DFS) and overall survival (OS) were the end points. Systematic assessment was performed using Stata 12.0.

RESULTS:

Twelve trials including 30,848 cases were involved. The overall analysis demonstrated that extended endocrine therapy to 10 years significantly prolonged DFS compared with 5 years of endocrine therapy [hazard ratio (HR) = 0.84, 95% CI: 0.73-0.97]. Subgroup analysis showed that DFS was significant prolonged with TAM 5y - AI 5y treatment versus TAM 5y treatment and with (AI and/or TAM) 5y - LET 5y treatment versus (AI and/or TAM) 5y treatment [(HR = 0.61, 95% CI: 0.50-0.76) and (HR = 0.81, 95% CI: 0.71-0.93), respectively]. However, no significant difference was found in the DFS with TAM 5y - TAM 5y treatment versus TAM 5y treatment (HR = 0.97, 95% CI: 0.81-1.17). Overall and subgroup analysis did not demonstrate an OS benefit of therapy extended to 10 years. A DFS benefit of extended endocrine therapy to 10 years was verified in the lymph node-positive subgroup, postmenopausal subgroup and ER+ and/or PR+ subgroup (HR = 058, 95% CI: 0.45-0.75; HR = 0.70, 95% CI: 0.58-0.80; HR = 0.80, 95% CI: 0.67-0.96).

CONCLUSIONS:

An extended 10 years of endocrine treatment yields a DFS benefit for patients with early breast cancer; (AI and/or TAM) 5y - AI 5y treatment is the optimal choice. ER+ and/or PR+, postmenopausal and lymph node-positive patients are the most suitable groups.

KEYWORDS:

Aromatase inhibitor; Breast cancer; Disease-free survival; Extended endocrine treatment; Tamoxifen

PMID:
30314452
PMCID:
PMC6186070
DOI:
10.1186/s12885-018-4878-4
[Indexed for MEDLINE]
Free PMC Article

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