Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study
Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monoth...
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| Veröffentlicht in: | Breast (Edinburgh) 2018-02, Vol.37, p.107-113 |
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| creator | Ferreira, Arlindo R. Palha, Ana Correia, Lurdes Filipe, Pedro Rodrigues, Vasco Miranda, Ana André, Rosário Fernandes, João Gouveia, Joaquim Passos-Coelho, José L. Moreira, António Brito, Margarida Ribeiro, Joana Metzger-Filho, Otto Lin, Nancy U. Costa, Luís Vaz-Luis, Inês |
| description | Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM).
This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions.
Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p |
| doi_str_mv | 10.1016/j.breast.2017.11.003 |
| format | Article |
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This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions.
Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37–0.81).
AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
•In HR+ breast cancer, randomized trials showed that: 1) adjuvant tamoxifen improved OS over no adjuvant endocrine therapy, and 2) adjuvant AI improved OS over tamoxifen. After 2005, AIs were recommended for postmenopausal women with HR+ BC.•In a cohort of 1283 patients with HR+ BC, 41% received an AI between 2006 and 2008.•Use differed by perceived risk of recurrence, but also by institution of care.•In this real life cohort the use of AI-based treatment was associated with a reduced risk of death of 45%.</description><identifier>ISSN: 0960-9776</identifier><identifier>EISSN: 1532-3080</identifier><identifier>DOI: 10.1016/j.breast.2017.11.003</identifier><identifier>PMID: 29131988</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Aromatase inhibitors ; Early breast cancer ; Tamoxifen ; Treatment effectiveness</subject><ispartof>Breast (Edinburgh), 2018-02, Vol.37, p.107-113</ispartof><rights>2017 Elsevier Ltd</rights><rights>Copyright © 2017 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-3f5a6e7a15eeb3023b17a3d632c1581d2cecbfa7e55976c148141ec687c649ce3</citedby><cites>FETCH-LOGICAL-c408t-3f5a6e7a15eeb3023b17a3d632c1581d2cecbfa7e55976c148141ec687c649ce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0960977617307737$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29131988$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferreira, Arlindo R.</creatorcontrib><creatorcontrib>Palha, Ana</creatorcontrib><creatorcontrib>Correia, Lurdes</creatorcontrib><creatorcontrib>Filipe, Pedro</creatorcontrib><creatorcontrib>Rodrigues, Vasco</creatorcontrib><creatorcontrib>Miranda, Ana</creatorcontrib><creatorcontrib>André, Rosário</creatorcontrib><creatorcontrib>Fernandes, João</creatorcontrib><creatorcontrib>Gouveia, Joaquim</creatorcontrib><creatorcontrib>Passos-Coelho, José L.</creatorcontrib><creatorcontrib>Moreira, António</creatorcontrib><creatorcontrib>Brito, Margarida</creatorcontrib><creatorcontrib>Ribeiro, Joana</creatorcontrib><creatorcontrib>Metzger-Filho, Otto</creatorcontrib><creatorcontrib>Lin, Nancy U.</creatorcontrib><creatorcontrib>Costa, Luís</creatorcontrib><creatorcontrib>Vaz-Luis, Inês</creatorcontrib><title>Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study</title><title>Breast (Edinburgh)</title><addtitle>Breast</addtitle><description>Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM).
This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions.
Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37–0.81).
AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
•In HR+ breast cancer, randomized trials showed that: 1) adjuvant tamoxifen improved OS over no adjuvant endocrine therapy, and 2) adjuvant AI improved OS over tamoxifen. After 2005, AIs were recommended for postmenopausal women with HR+ BC.•In a cohort of 1283 patients with HR+ BC, 41% received an AI between 2006 and 2008.•Use differed by perceived risk of recurrence, but also by institution of care.•In this real life cohort the use of AI-based treatment was associated with a reduced risk of death of 45%.</description><subject>Aromatase inhibitors</subject><subject>Early breast cancer</subject><subject>Tamoxifen</subject><subject>Treatment effectiveness</subject><issn>0960-9776</issn><issn>1532-3080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1DAQhi1ERZfCGyDkI5cET5w4CQekqmoBqVIv5WxN7InwKrEX21mxD8O7klUWjpxsS9_MP-OPsXcgShCgPu7LIRKmXFYC2hKgFEK-YDtoZFVI0YmXbCd6JYq-bdU1e53SXgjRS9W9YtdVDxL6rtux389rkzyTzxxtOGQXPEdveaQJszsSp3Ekc755SomHkWMMM2ZMxJ3_4QaXQ0zchPmAkSzPgWecwy83kl8BThinE98m5Qa9ofiJ3_J5mbIrnE_Z5eUcihMPQ6J4xMsr5cWe3rCrEadEby_nDfv-cP9897V4fPry7e72sTC16HIhxwYVtQgN0SBFJQdoUVolKwNNB7YyZIYRW2qavlUG6g5qIKO61qi6NyRv2Iet7yGGnwulrGeXDE0TegpL0tCrulK9qsSK1htqYkgp0qgP0c0YTxqEPovRe72tq89iNIBexaxl7y8JyzCT_Vf018QKfN4AWvc8Ooo6GUfrf1kXVwHaBvf_hD-2mKXU</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Ferreira, Arlindo R.</creator><creator>Palha, Ana</creator><creator>Correia, Lurdes</creator><creator>Filipe, Pedro</creator><creator>Rodrigues, Vasco</creator><creator>Miranda, Ana</creator><creator>André, Rosário</creator><creator>Fernandes, João</creator><creator>Gouveia, Joaquim</creator><creator>Passos-Coelho, José L.</creator><creator>Moreira, António</creator><creator>Brito, Margarida</creator><creator>Ribeiro, Joana</creator><creator>Metzger-Filho, Otto</creator><creator>Lin, Nancy U.</creator><creator>Costa, Luís</creator><creator>Vaz-Luis, Inês</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study</title><author>Ferreira, Arlindo R. ; 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In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM).
This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions.
Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37–0.81).
AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
•In HR+ breast cancer, randomized trials showed that: 1) adjuvant tamoxifen improved OS over no adjuvant endocrine therapy, and 2) adjuvant AI improved OS over tamoxifen. After 2005, AIs were recommended for postmenopausal women with HR+ BC.•In a cohort of 1283 patients with HR+ BC, 41% received an AI between 2006 and 2008.•Use differed by perceived risk of recurrence, but also by institution of care.•In this real life cohort the use of AI-based treatment was associated with a reduced risk of death of 45%.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>29131988</pmid><doi>10.1016/j.breast.2017.11.003</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Breast (Edinburgh), 2018-02, Vol.37, p.107-113 |
| issn | 0960-9776 1532-3080 |
| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | Aromatase inhibitors Early breast cancer Tamoxifen Treatment effectiveness |
| title | Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study |
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