Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial

Summary Background Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at hig...

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Veröffentlicht in:The Lancet (British edition) 2014-03, Vol.383 (9922), p.1041-1048
Hauptverfasser: Cuzick, Jack, Prof, Sestak, Ivana, PhD, Forbes, John F, Prof, Dowsett, Mitch, Prof, Knox, Jill, MSc, Cawthorn, Simon, MD, Saunders, Christobel, Prof, Roche, Nicola, MD, Mansel, Robert E, Prof, von Minckwitz, Gunter, MD, Bonanni, Bernardo, MD, Palva, Tiina, MD, Howell, Anthony, Prof
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container_issue 9922
container_start_page 1041
container_title The Lancet (British edition)
container_volume 383
creator Cuzick, Jack, Prof
Sestak, Ivana, PhD
Forbes, John F, Prof
Dowsett, Mitch, Prof
Knox, Jill, MSc
Cawthorn, Simon, MD
Saunders, Christobel, Prof
Roche, Nicola, MD
Mansel, Robert E, Prof
von Minckwitz, Gunter, MD
Bonanni, Bernardo, MD
Palva, Tiina, MD
Howell, Anthony, Prof
description Summary Background Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. Methods Between Feb 2, 2003, and Jan 31, 2012, we recruited postmenopausal women aged 40–70 years from 18 countries into an international, double-blind, randomised placebo-controlled trial. To be eligible, women had to be at increased risk of breast cancer (judged on the basis of specific criteria). Eligible women were randomly assigned (1:1) by central computer allocation to receive 1 mg oral anastrozole or matching placebo every day for 5 years. Randomisation was stratified by country and was done with blocks (size six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation; only the trial statistician was unmasked. The primary endpoint was histologically confirmed breast cancer (invasive cancers or non-invasive ductal carcinoma in situ). Analyses were done by intention to treat. This trial is registered, number ISRCTN31488319. Findings 1920 women were randomly assigned to receive anastrozole and 1944 to placebo. After a median follow-up of 5·0 years (IQR 3·0–7·1), 40 women in the anastrozole group (2%) and 85 in the placebo group (4%) had developed breast cancer (hazard ratio 0·47, 95% CI 0·32–0·68, p
doi_str_mv 10.1016/S0140-6736(13)62292-8
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We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. Methods Between Feb 2, 2003, and Jan 31, 2012, we recruited postmenopausal women aged 40–70 years from 18 countries into an international, double-blind, randomised placebo-controlled trial. To be eligible, women had to be at increased risk of breast cancer (judged on the basis of specific criteria). Eligible women were randomly assigned (1:1) by central computer allocation to receive 1 mg oral anastrozole or matching placebo every day for 5 years. Randomisation was stratified by country and was done with blocks (size six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation; only the trial statistician was unmasked. The primary endpoint was histologically confirmed breast cancer (invasive cancers or non-invasive ductal carcinoma in situ). Analyses were done by intention to treat. This trial is registered, number ISRCTN31488319. Findings 1920 women were randomly assigned to receive anastrozole and 1944 to placebo. After a median follow-up of 5·0 years (IQR 3·0–7·1), 40 women in the anastrozole group (2%) and 85 in the placebo group (4%) had developed breast cancer (hazard ratio 0·47, 95% CI 0·32–0·68, p&lt;0·0001). The predicted cumulative incidence of all breast cancers after 7 years was 5·6% in the placebo group and 2·8% in the anastrozole group. 18 deaths were reported in the anastrozole group and 17 in the placebo group, and no specific causes were more common in one group than the other (p=0·836). Interpretation Anastrozole effectively reduces incidence of breast cancer in high-risk postmenopausal women. This finding, along with the fact that most of the side-effects associated with oestrogen deprivation were not attributable to treatment, provides support for the use of anastrozole in postmenopausal women at high risk of breast cancer. Funding Cancer Research UK, the National Health and Medical Research Council Australia, Sanofi-Aventis, and AstraZeneca.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(13)62292-8</identifier><identifier>PMID: 24333009</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier</publisher><subject>Adult ; Aged ; Anastrozole ; Antineoplastic Agents, Hormonal - therapeutic use ; Aromatase Inhibitors - therapeutic use ; Biological and medical sciences ; Bone density ; Breast cancer ; Breast Neoplasms - prevention &amp; control ; Carcinoma, Ductal, Breast - prevention &amp; control ; Carcinoma, Intraductal, Noninfiltrating - prevention &amp; control ; Carcinoma, Lobular - prevention &amp; control ; Double-Blind Method ; Female ; General aspects ; Gynecology. Andrology. Obstetrics ; Hormone replacement therapy ; Humans ; Internal Medicine ; Longitudinal Studies ; Mammary gland diseases ; Mammography ; Medical research ; Medical sciences ; Middle Aged ; Nitriles - therapeutic use ; Postmenopause ; Prevention ; Prevention and actions ; Proportional Hazards Models ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Factors ; Treatment Outcome ; Triazoles - therapeutic use ; Tumors ; Womens health</subject><ispartof>The Lancet (British edition), 2014-03, Vol.383 (9922), p.1041-1048</ispartof><rights>Cuzick et al. Open Access article distributed under the terms of CC BY</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Cuzick et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 22, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-40af7618d116f203a03b00bdbe2627a51893db890d966559db237750a2f515e73</citedby><cites>FETCH-LOGICAL-c554t-40af7618d116f203a03b00bdbe2627a51893db890d966559db237750a2f515e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=28259768$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24333009$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cuzick, Jack, Prof</creatorcontrib><creatorcontrib>Sestak, Ivana, PhD</creatorcontrib><creatorcontrib>Forbes, John F, Prof</creatorcontrib><creatorcontrib>Dowsett, Mitch, Prof</creatorcontrib><creatorcontrib>Knox, Jill, MSc</creatorcontrib><creatorcontrib>Cawthorn, Simon, MD</creatorcontrib><creatorcontrib>Saunders, Christobel, Prof</creatorcontrib><creatorcontrib>Roche, Nicola, MD</creatorcontrib><creatorcontrib>Mansel, Robert E, Prof</creatorcontrib><creatorcontrib>von Minckwitz, Gunter, MD</creatorcontrib><creatorcontrib>Bonanni, Bernardo, MD</creatorcontrib><creatorcontrib>Palva, Tiina, MD</creatorcontrib><creatorcontrib>Howell, Anthony, Prof</creatorcontrib><creatorcontrib>IBIS-II investigators</creatorcontrib><title>Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. Methods Between Feb 2, 2003, and Jan 31, 2012, we recruited postmenopausal women aged 40–70 years from 18 countries into an international, double-blind, randomised placebo-controlled trial. To be eligible, women had to be at increased risk of breast cancer (judged on the basis of specific criteria). Eligible women were randomly assigned (1:1) by central computer allocation to receive 1 mg oral anastrozole or matching placebo every day for 5 years. Randomisation was stratified by country and was done with blocks (size six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation; only the trial statistician was unmasked. The primary endpoint was histologically confirmed breast cancer (invasive cancers or non-invasive ductal carcinoma in situ). Analyses were done by intention to treat. This trial is registered, number ISRCTN31488319. Findings 1920 women were randomly assigned to receive anastrozole and 1944 to placebo. After a median follow-up of 5·0 years (IQR 3·0–7·1), 40 women in the anastrozole group (2%) and 85 in the placebo group (4%) had developed breast cancer (hazard ratio 0·47, 95% CI 0·32–0·68, p&lt;0·0001). The predicted cumulative incidence of all breast cancers after 7 years was 5·6% in the placebo group and 2·8% in the anastrozole group. 18 deaths were reported in the anastrozole group and 17 in the placebo group, and no specific causes were more common in one group than the other (p=0·836). Interpretation Anastrozole effectively reduces incidence of breast cancer in high-risk postmenopausal women. This finding, along with the fact that most of the side-effects associated with oestrogen deprivation were not attributable to treatment, provides support for the use of anastrozole in postmenopausal women at high risk of breast cancer. Funding Cancer Research UK, the National Health and Medical Research Council Australia, Sanofi-Aventis, and AstraZeneca.</description><subject>Adult</subject><subject>Aged</subject><subject>Anastrozole</subject><subject>Antineoplastic Agents, Hormonal - therapeutic use</subject><subject>Aromatase Inhibitors - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bone density</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - prevention &amp; control</subject><subject>Carcinoma, Ductal, Breast - prevention &amp; control</subject><subject>Carcinoma, Intraductal, Noninfiltrating - prevention &amp; control</subject><subject>Carcinoma, Lobular - prevention &amp; control</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>General aspects</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hormone replacement therapy</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Longitudinal Studies</subject><subject>Mammary gland diseases</subject><subject>Mammography</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nitriles - therapeutic use</subject><subject>Postmenopause</subject><subject>Prevention</subject><subject>Prevention and actions</subject><subject>Proportional Hazards Models</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cuzick, Jack, Prof</au><au>Sestak, Ivana, PhD</au><au>Forbes, John F, Prof</au><au>Dowsett, Mitch, Prof</au><au>Knox, Jill, MSc</au><au>Cawthorn, Simon, MD</au><au>Saunders, Christobel, Prof</au><au>Roche, Nicola, MD</au><au>Mansel, Robert E, Prof</au><au>von Minckwitz, Gunter, MD</au><au>Bonanni, Bernardo, MD</au><au>Palva, Tiina, MD</au><au>Howell, Anthony, Prof</au><aucorp>IBIS-II investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2014-03-22</date><risdate>2014</risdate><volume>383</volume><issue>9922</issue><spage>1041</spage><epage>1048</epage><pages>1041-1048</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. Methods Between Feb 2, 2003, and Jan 31, 2012, we recruited postmenopausal women aged 40–70 years from 18 countries into an international, double-blind, randomised placebo-controlled trial. To be eligible, women had to be at increased risk of breast cancer (judged on the basis of specific criteria). Eligible women were randomly assigned (1:1) by central computer allocation to receive 1 mg oral anastrozole or matching placebo every day for 5 years. Randomisation was stratified by country and was done with blocks (size six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation; only the trial statistician was unmasked. The primary endpoint was histologically confirmed breast cancer (invasive cancers or non-invasive ductal carcinoma in situ). Analyses were done by intention to treat. This trial is registered, number ISRCTN31488319. Findings 1920 women were randomly assigned to receive anastrozole and 1944 to placebo. After a median follow-up of 5·0 years (IQR 3·0–7·1), 40 women in the anastrozole group (2%) and 85 in the placebo group (4%) had developed breast cancer (hazard ratio 0·47, 95% CI 0·32–0·68, p&lt;0·0001). The predicted cumulative incidence of all breast cancers after 7 years was 5·6% in the placebo group and 2·8% in the anastrozole group. 18 deaths were reported in the anastrozole group and 17 in the placebo group, and no specific causes were more common in one group than the other (p=0·836). Interpretation Anastrozole effectively reduces incidence of breast cancer in high-risk postmenopausal women. This finding, along with the fact that most of the side-effects associated with oestrogen deprivation were not attributable to treatment, provides support for the use of anastrozole in postmenopausal women at high risk of breast cancer. Funding Cancer Research UK, the National Health and Medical Research Council Australia, Sanofi-Aventis, and AstraZeneca.</abstract><cop>Kidlington</cop><pub>Elsevier</pub><pmid>24333009</pmid><doi>10.1016/S0140-6736(13)62292-8</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0140-6736
ispartof The Lancet (British edition), 2014-03, Vol.383 (9922), p.1041-1048
issn 0140-6736
1474-547X
language eng
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source MEDLINE; Elsevier ScienceDirect Journals
subjects Adult
Aged
Anastrozole
Antineoplastic Agents, Hormonal - therapeutic use
Aromatase Inhibitors - therapeutic use
Biological and medical sciences
Bone density
Breast cancer
Breast Neoplasms - prevention & control
Carcinoma, Ductal, Breast - prevention & control
Carcinoma, Intraductal, Noninfiltrating - prevention & control
Carcinoma, Lobular - prevention & control
Double-Blind Method
Female
General aspects
Gynecology. Andrology. Obstetrics
Hormone replacement therapy
Humans
Internal Medicine
Longitudinal Studies
Mammary gland diseases
Mammography
Medical research
Medical sciences
Middle Aged
Nitriles - therapeutic use
Postmenopause
Prevention
Prevention and actions
Proportional Hazards Models
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
Treatment Outcome
Triazoles - therapeutic use
Tumors
Womens health
title Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial
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