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Efficacy of extended aromatase inhibitors for hormone-receptor–positive breast cancer: A literature-based meta-analysis of randomized trials
- Publication Year :
- 2019
-
Abstract
- Background Endocrine treatment with Tamoxifen and aromatase inhibitors (AIs) is a staple in the management of hormone receptor positive breast cancer (HR + BC). It has become clear that HR + BC carries a consistent risk of relapse up to 15 years post-diagnosis. While increasing evidence supports the use of extended adjuvant Tamoxifen over 5 years, controversial data are available on the optimal duration of extended AIs adjuvant treatment. We performed a meta-analysis to assess the real impact of extended adjuvant therapy with AIs on disease-free survival (DFS). Methods A literature-based meta-analysis of randomized controlled trials (RCTs) was undertaken. Relevant publications from PubMed, the Cochrane Library, and abstracts from American Society of Clinical Oncology (ASCO) and San Antonio Breast Cancer (SABCS) symposia were searched. Primary and secondary endpoints were Disease Free Survival (DFS) and overall survival (OS) respectively. A subgroup analysis was also performed to elucidate the impact of nodal involvement. Results The pooled analysis revealed a significant increase in DFS in the extended AIs group (hazard ratio (HR): 0.78, 95% CI: 0.68–0.90; P = 0.0006). The subgroup analysis according to nodal status showed a greater DFS benefit with extended AIs in patients with positive nodes (HR = 0.67 versus 0.80). Our analysis also demonstrated no improvement in OS with extended AIs (HR = 0.99, 95%CI: 0.87–1.12; P = 0.84). Conclusion This work confirmed the efficacy of extended adjuvant treatment with AIs for HR + early breast cancer, with a 22% increase in DFS, but no impact on OS. Greater efficacy was observed in women with positive nodal status.
- Subjects :
- Oncology
medicine.medical_specialty
Hormone-positive BC
Antineoplastic Agents, Hormonal
Receptor, ErbB-2
AIs
Extended adjuvant AIs
Subgroup analysis
Breast Neoplasms
Cochrane Library
Disease-Free Survival
law.invention
03 medical and health sciences
0302 clinical medicine
Breast cancer
Adjuvant endocrine therapy
Randomized controlled trial
law
Aromatase inhibitors
Extended adjuvant endocrine treatment
HR+
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Adjuvant therapy
Humans
030212 general & internal medicine
Proportional Hazards Models
Randomized Controlled Trials as Topic
business.industry
Hazard ratio
General Medicine
Aromatase inhibitor
medicine.disease
Tamoxifen
Treatment Outcome
Chemotherapy, Adjuvant
AI
030220 oncology & carcinogenesis
Meta-analysis
Extended adjuvant AI
Surgery
Female
business
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....c991ce5aeaa6124f8ee64414703c327d