PracticeUpdate: Haematology & Oncology
PracticeUpdate Oncology Advisory Board member Jeffrey Kirshner MD, FACP, and breast cancer treatment expert and advocate for breast cancer patients, Lillie Shockney RN, BS, MAS, discuss their top stories in oncology for 2016, focusing on breast cancer – aromatase inhibitors and survival rates. Aromatase inhibitors in breast cancer By Jeffrey Kirshner MD, FACP A lthough the increasing indications and usage of checkpoint inhibitors for multiple malignancies 2016 Top Stories in Oncology
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because of the number of patients that it affects. There are hundreds of thousands of women receivingAI therapy at the present time in the United States (and many more worldwide!). Most practicing general oncologists see these patients on a daily basis and need to present these data to their patients at some point. They will have to discuss the pros and cons of whether to extend AI therapy to 10 years. It is not always a straightforward decision. One must take into account individual prognostic factors, comorbidity, life expectancy, bone health, and, of course, each patient’s wishes. Even though extended therapy has not affected overall survival (yet!), decreasing recurrences and fewer new breast cancers are obviously important goals. Is 10 years ofAI therapy the new standard of care for postmenopausal women with early-stage breast cancer? I would argue that it should be considered, taking into account the aforementioned factors; but, ultimately, the decision should be made by the patient with advice from her oncologist. Of course, many questions remain, including: Do we consider restarting AI in patients who had completed their treatment several years earlier? Are there certain high-risk patients who should continue AI beyond 10 years? Do the patients who have had tamoxifen prior to their 5 years of AI benefit as much as those who did not receive tamoxifen? We all anxiously await results from the NSABP B-42 study, which had a very similar design. Further breakdown and follow-up of these two studies will enable us to make even better decisions regarding the use of extendedAI therapy.
continues to be a “top story,” I have chosen another “story,” which arguably may affect even more patients presently. Oncologists are now offering an additional 5 years of aromatase inhibitor (AI) therapy (for a total of 10 years) to patients receiving these drugs as adjuvant therapy for early-stage breast cancer. This recommendation is based on the initial results of the MA.17R study, which was the first presentation at the ASCO Annual Meeting Plenary Session in June 2016 (Goss PE et al, MA.17R, Abstract LBA1). Study results were immediately presented online in The New England Journal of Medicine and subsequently published as a lead article the following month ( N Engl J Med 2016;375:209-219). In this international, multi-institutional study, over 1900 women were randomised to an additional 5 years of letrozole versus placebo (after completing an initial 5 years of letrozole and remaining disease-free). At a median follow-up of over 6 years, letrozole-treated patients had 67 “events” as opposed to 98 in the placebo group. This translated to an improvement in 5-year disease- free survival from 91% to 95%. There were fewer local–regional and distant recurrences in the treatment group and fewer cancers in the contralateral breast. To date, there has been no difference in overall survival. As expected, the patients randomised to additional letrozole had a slightly higher incidence of bone pain, fractures, and new-onset osteoporosis. There were no unexpected adverse events in the treatment group. This story is particularly important
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