Letrozole another option after tamoxifen therapy
Postmenopausal women with early breast cancer who have completed standard adjuvant tamoxifen therapy now have the option of further treatment following the extension to the licence of letrozole (Femara).
After surgery, standard hormonal therapy for postmenopausal women with
early breast cancer is tamoxifen, usually for five years. After this,
there is no evidence of further benefit and treatment is usually stopped
because of increased risk of endometrial cancer, pulmonary embolism and
stroke. About a third of patients who are oestrogen-receptor positive
experience recurrence and over half of these occur after treatment is
stopped.
Now these women can switch to the aromatase inhibitor letrozole, which
can be taken for up to three years and has been shown to reduce recurrence.
The trial supporting this (the MA-17 study) showed that letrozole after
standard tamoxifen therapy reduces recurrence by 42 per cent (P=0.00004)
and reduces distant metastases by 39 per cent (P=0.003) (PJ, 18 October
2003, p536). An increased risk of osteoporosis was recorded, although
with no higher risk of fractures than with placebo. Letrozole costs £83.16
per patient per month.
Letrozole is also licensed for the first-line treatment of advanced breast
cancer in postmenopausal women who are oestrogen receptor positive or
unknown, in women with advanced breast cancer with disease progression
after anti-oestrogen therapy, and as preoperative therapy. The Breast
International Group in collaboration with Novartis Oncology is currently
conducting a study to assess whether letrozole is more effective than
tamoxifen in the treatment of early cancer after surgery. Preliminary
results are expected by the end of the year.
Notice-board, p377 |
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