Letrozole Vs.Tamoxifen

Letrozole Superior to Tamoxifen For Treatment of Advanced Breast Cancer

J Clin Oncol 2001;19:2596-2606.

WESTPORT, CT (Reuters Health)- Letrozole is significantly more efficacious than tamoxifen as first-line endocrine therapy for postmenopausal women with advanced breast cancer, according to a multinational research team.

The investigators describe the study as the single largest to date that has been conducted with an aromatase inhibitor as first-line endocrine treatment of advanced breast cancer.

Dr. Hilary A. Chaudri-Ross, of Novartis Pharma AG in Basel, Switzerland, and colleagues treated patients from 201 centers in 29 countries who had stage IIIB breast cancer, or loco-regionally recurrent disease not amenable to surgery or radiation therapy, or metastatic disease. Therapy with letrozole 2.5 mg/day was randomly assigned to 453 patients and tamoxifen 20 mg/day to 454 patients.

As described in the Journal of Clinical Oncology for May 15, tumors were estrogen receptor- and/or progesterone receptor-positive, or else the status of both receptors was unknown. Some patients had had one regimen of chemotherapy.

Letrozole reduced the risk of progression by 30% compared with tamoxifen. Median time to progression was 41 weeks for letrozole and 26 weeks for tamoxifen. Letrozole was also significantly superior in time to treatment failure, objective response rate, and rate of clinical benefit.

The investigators note that the results were maintained after adjustment for receptor status, prior adjuvant antiestrogen therapy, and dominant site of disease. Adverse events were similar in nature and frequency for the two drugs.

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