Originally published as JCO Early Release 10.1200/JCO.2005.09.121 on November 15 2004
Journal of Clinical Oncology, Vol 23, No 3 (January 20), 2005: pp. 619-629
© 2005 American Society of Clinical Oncology.
American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor–Positive Breast Cancer: Status Report 2004
Eric P. Winer,
Clifford Hudis,
Harold J. Burstein,
Antonio C. Wolff,
Kathleen I. Pritchard,
James N. Ingle,
Rowan T. Chlebowski,
Richard Gelber,
Stephan B. Edge,
Julie Gralow,
Melody A. Cobleigh,
Eleftherios P. Mamounas,
Lori J. Goldstein,
Timothy J. Whelan,
Trevor J. Powles,
John Bryant,
Cheryl Perkins,
Judy Perotti,
Susan Braun,
Amy S. Langer,
George P. Browman,
Mark R. Somerfield
From Cancer Policy and Clinical Affairs, American Society of Clinical Oncology, Alexandria, VA
Address reprint requests to Eric P. Winer, MD, Dana-Farber Cancer Institute, 44 Binney St, D1210, Boston, MA 02115; e-mail: ewiner{at}partners.org
PURPOSE: To update the 2003 American Society of Clinical Oncology technology assessment on adjuvant use of aromatase inhibitors.
RECOMMENDATIONS: Based on results from multiple large randomized trials, adjuvant therapy for postmenopausal women with hormone receptor–positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumor recurrence. Neither the optimal timing nor duration of aromatase inhibitor therapy is established. Aromatase inhibitors are appropriate as initial treatment for women with contraindications to tamoxifen. For all other postmenopausal women, treatment options include 5 years of aromatase inhibitors treatment or sequential therapy consisting of tamoxifen (for either 2 to 3 years or 5 years) followed by aromatase inhibitors for 2 to 3, or 5 years. Patients intolerant of aromatase inhibitors should receive tamoxifen. There are no data on the use of tamoxifen after an aromatase inhibitor in the adjuvant setting. Women with hormone receptor–negative tumors should not receive adjuvant endocrine therapy. The role of other biomarkers such as progesterone receptor and HER2 status in selecting optimal endocrine therapy remains controversial. Aromatase inhibitors are contraindicated in premenopausal women; there are limited data concerning their role in women with treatment-related amenorrhea. The side effect profiles of tamoxifen and aromatase inhibitors differ. The late consequences of aromatase inhibitor therapy, including osteoporosis, are not well characterized.
CONCLUSION: The Panel believes that optimal adjuvant hormonal therapy for a postmenopausal woman with receptor-positive breast cancer includes an aromatase inhibitor as initial therapy or after treatment with tamoxifen. Women with breast cancer and their physicians must weigh the risks and benefits of all therapeutic options.
Authors' disclosures of potential conflicts of interest are found at the end of this article.
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