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Alard A, Katsara O, Rios-Fuller T, Parra CDL, Ozerdem U, Ernlund A, Schneider RJ. Breast cancer cell mesenchymal transition and metastasis directed by DAP5/eIF3d-mediated selective mRNA translation. Cell Rep 2023; 42:112646. [PMID: 37314929 PMCID: PMC10895648 DOI: 10.1016/j.celrep.2023.112646] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
Cancer cell plasticity enables cell survival in harsh physiological environments and fate transitions such as the epithelial-to-mesenchymal transition (EMT) that underlies invasion and metastasis. Using genome-wide transcriptomic and translatomic studies, an alternate mechanism of cap-dependent mRNA translation by the DAP5/eIF3d complex is shown to be essential for metastasis, EMT, and tumor directed angiogenesis. DAP5/eIF3d carries out selective translation of mRNAs encoding EMT transcription factors and regulators, cell migration integrins, metalloproteinases, and cell survival and angiogenesis factors. DAP5 is overexpressed in metastatic human breast cancers associated with poor metastasis-free survival. In human and murine breast cancer animal models, DAP5 is not required for primary tumor growth but is essential for EMT, cell migration, invasion, metastasis, angiogenesis, and resistance to anoikis. Thus, cancer cell mRNA translation involves two cap-dependent mRNA translation mechanisms, eIF4E/mTORC1 and DAP5/eIF3d. These findings highlight a surprising level of plasticity in mRNA translation during cancer progression and metastasis.
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Affiliation(s)
- Amandine Alard
- Department of Microbiology, NYU School of Medicine, New York, NY 10016, USA
| | - Olga Katsara
- Department of Microbiology, NYU School of Medicine, New York, NY 10016, USA
| | | | | | - Ugur Ozerdem
- Department of Pathology, NYU School of Medicine, New York, NY 10016, USA
| | - Amanda Ernlund
- Department of Microbiology, NYU School of Medicine, New York, NY 10016, USA
| | - Robert J Schneider
- Department of Microbiology, NYU School of Medicine, New York, NY 10016, USA
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Iwata H, Yamamoto Y, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Ohtani S, Kashiwaba M, Taira N, Toyama T, Fujisawa T, Masuda N, Shibahara Y, Sasano H, Yamaguchi T. Phase III study of long-term prognosis of estrogen receptor-positive early breast cancer treated with neoadjuvant endocrine therapy with/without adjuvant chemotherapy. Breast Cancer Res Treat 2023; 199:231-241. [PMID: 36947277 PMCID: PMC10175450 DOI: 10.1007/s10549-023-06874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Neoadjuvant endocrine therapy (NET) is a treatment option for estrogen receptor-positive (ER+) postmenopausal early breast cancer (EBC). This phase III trial evaluated the prognosis of EBC patients treated with/without chemotherapy (CT) following NET. METHODS ER+/HER2-, T1c-2, and clinically node-negative EBC patients were enrolled in 2008-2013 and treated with endocrine therapy (ET) in weeks 24-28. All patients, excluding those with progressive disease (PD) during NET or ≥ 4 positive lymph nodes after surgery, were randomized to ET for 4.5-5 years with/without CT. The primary endpoint was disease-free survival (DFS). Secondary endpoints included distant DFS (DDFS), overall survival (OS), and DFS/DDFS/OS according to clinical response to NET. RESULTS Of 904 patients, 669 were randomized to CT+ET (n = 333) or ET alone (n = 336). The median follow-up was 7.8 years. DFS (CT+ET, 47 events; ET alone, 70 events) and DDFS did not reach the planned numbers of events. Eight-year DFS/DDFS rates were 86%/93% and 83%/92%, respectively. DFS was significantly better in CT+ET than ET alone in subgroups aged < 60 years (P = 0.016), T2 (P = 0.013), or Ki67 > 20% (P = 0.026). Progesterone receptor and histological grade were predictive markers for clinical responses to NET. CONCLUSION NET may be used as standard treatment for patients with ER+EBC. Although it is difficult to decide whether to administer adjuvant CT based solely on the effect of NET, the response to NET may help to inform this decision. TRIAL REGISTRATION This study was registered at the UMIN Clinical Trials Registry under UMIN000001090 (registered 20 March 2008).
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Affiliation(s)
- Hiroji Iwata
- Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
| | - Yutaka Yamamoto
- Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takehiko Sakai
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, 38-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yoshie Hasegawa
- Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe, 031-8555, Japan
| | - Rikiya Nakamura
- Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Hiromitsu Akabane
- Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, 1-24-111, Asahikawa, 078-8211, Japan
| | - Shoichiro Ohtani
- Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Masahiro Kashiwaba
- Adachi Breast Clinic, 98 Kamigamo Matsumoto-cho, Kita-ku, Kyoto, 603-8052, Japan
| | - Naruto Taira
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tatsuya Toyama
- Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tomomi Fujisawa
- Gunma Prefectural Cancer Center, 617-1 Takahayashinishi-cho, Ota, Gunma, 373-8550, Japan
| | - Norikazu Masuda
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukiko Shibahara
- Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Kitasato University, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hironobu Sasano
- Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takuhiro Yamaguchi
- Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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3
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Ghanavati M, Khorshidi Y, Shadnoush M, Akbari ME, Ardehali SH, Chavarri-Guerra Y, Akbari A, Barragan-Carrillo R, Amin Amlashi M, Javid Z, Rahmani J. Tamoxifen use and risk of endometrial cancer in breast cancer patients: A systematic review and dose-response meta-analysis. Cancer Rep (Hoboken) 2023; 6:e1806. [PMID: 36916539 PMCID: PMC10075294 DOI: 10.1002/cnr2.1806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Worse prognosis of endometrial cancers (EC) in tamoxifen-treated women compared to non-tamoxifen-treated women been proposed. The relationship between tamoxifen treatment of breast cancer (BC) and the risk of EC is controversial and there is no agreement between publication results on this issue (the answer to all comments provided in the page 2 of manuscript). The aim of this study is investigation the association between tamoxifen treatment and the risk of EC in patients with BC. METHODS AND RESULTS We conducted a comprehensive search with related keywords in MEDLINE/PubMed, SCOPUS, and Web of Science databases until April 16, 2022. Random-effects model (DerSimonian and Laird) was used to pool risk ratios (RRs) with 95% confidence intervals (CIs) of EC. Dose, cumulative dose, and duration-response analysis were performed in linear and non-linear states. Twenty-six studies reported a relation between tamoxifen treatment and risk of EC in patients with BC. Results showed a direct relationship between tamoxifen use and EC (RR: 2.03, 95% CI: 1.68-2.45; I2:76%). By increase the age of participants, the risk of EC was decrease (coef = -.0206), although this was not statistically significant (p = .37). Linear dose-response model indicated a direct significant association between dose and duration use of tamoxifen and EC (dose: exe(b) = 1.019, p = .001; duration: exe(b) = 1.014, p = .001). Non-linear dose-response analysis confirmed linear analysis. CONCLUSION This study highlights that tamoxifen use is a significant risk factor related to the incidence of EC in patients with BC.
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Affiliation(s)
- Matin Ghanavati
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Khorshidi
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Shadnoush
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Hossein Ardehali
- Department of Anesthesiology and Critical Care, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Regina Barragan-Carrillo
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Manoochehr Amin Amlashi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Javid
- Department of Nutrition, Farhikhtegan hospital, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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4
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Hagan ML, Mander S, Joseph C, Mcgrath M, Barrett A, Lewis A, Hill WD, Browning D, Mcgee-Lawrence ME, Cai H, Liu K, Barrett JT, Gewirtz DA, Thangaraju M, Schoenlein PV. Upregulation of the EGFR/MEK1/MAPK1/2 signaling axis as a mechanism of resistance to antiestrogen‑induced BimEL dependent apoptosis in ER + breast cancer cells. Int J Oncol 2022; 62:20. [PMID: 36524361 PMCID: PMC9854236 DOI: 10.3892/ijo.2022.5468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) is commonly upregulated in multiple cancer types, including breast cancer. In the present study, evidence is provided in support of the premise that upregulation of the EGFR/MEK1/MAPK1/2 signaling axis during antiestrogen treatment facilitates the escape of breast cancer cells from BimEL‑dependent apoptosis, conferring resistance to therapy. This conclusion is based on the findings that ectopic BimEL cDNA overexpression and confocal imaging studies confirm the pro‑apoptotic role of BimEL in ERα expressing breast cancer cells and that upregulated EGFR/MEK1/MAPK1/2 signaling blocks BimEL pro‑apoptotic action in an antiestrogen‑resistant breast cancer cell model. In addition, the present study identified a pro‑survival role for autophagy in antiestrogen resistance while EGFR inhibitor studies demonstrated that a significant percentage of antiestrogen‑resistant breast cancer cells survive EGFR targeting by pro‑survival autophagy. These pre‑clinical studies establish the possibility that targeting both the MEK1/MAPK1/2 signaling axis and pro‑survival autophagy may be required to eradicate breast cancer cell survival and prevent the development of antiestrogen resistance following hormone treatments. The present study uniquely identified EGFR upregulation as one of the mechanisms breast cancer cells utilize to evade the cytotoxic effects of antiestrogens mediated through BimEL‑dependent apoptosis.
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Affiliation(s)
- Mackenzie L. Hagan
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Suchreet Mander
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Carol Joseph
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Michael Mcgrath
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amanda Barrett
- Department of Pathology, Augusta University, Augusta, GA 30912, USA,Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Allison Lewis
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA
| | - William D. Hill
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Darren Browning
- Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA,Department of Biochemistry, Augusta University, Augusta, GA 30912, USA
| | | | - Haifeng Cai
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA,Department of Surgical Oncology, Tangshan People's Hospital, Tangshan, Hebei 063000, P.R. China
| | - Kebin Liu
- Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA,Department of Biochemistry, Augusta University, Augusta, GA 30912, USA
| | - John T. Barrett
- Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA,Department of Radiation Oncology, Augusta University, Augusta, GA 30912, USA
| | - David A. Gewirtz
- Department of Pharmacology and Toxicology, Massey Cancer Center, Richmond, VA 23298, USA
| | - Muthusamy Thangaraju
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA,Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Patricia V. Schoenlein
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA,Department of Medical College of Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA,Correspondence to: Dr Patricia V. Schoenlein, Department of Cellular Biology and Anatomy, Augusta University, Research and Education Building Room 2912, 1120 15th Street, Augusta, GA 30912, USA, E-mail:
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5
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Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, Gelmon K, Whelan T, Strasser-Weippl K, Rubin S, Sturtz K, Wolff AC, Winer E, Hudis C, Stopeck A, Beck JT, Kaur JS, Whelan K, Tu D, Parulekar WR. Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. N Engl J Med 2016; 375:209-219. [PMID: 27264120 PMCID: PMC5024713 DOI: 10.1056/nejmoa1604700#t=article] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Treatment with an aromatase inhibitor for 5 years as up-front monotherapy or after tamoxifen therapy is the treatment of choice for hormone-receptor-positive early breast cancer in postmenopausal women. Extending treatment with an aromatase inhibitor to 10 years may further reduce the risk of breast-cancer recurrence. METHODS We conducted a double-blind, placebo-controlled trial to assess the effect of the extended use of letrozole for an additional 5 years. Our primary end point was disease-free survival. RESULTS We enrolled 1918 women. After a median follow-up of 6.3 years, there were 165 events involving disease recurrence or the occurrence of contralateral breast cancer (67 with letrozole and 98 with placebo) and 200 deaths (100 in each group). The 5-year disease-free survival rate was 95% (95% confidence interval [CI], 93 to 96) with letrozole and 91% (95% CI; 89 to 93) with placebo (hazard ratio for disease recurrence or the occurrence of contralateral breast cancer, 0.66; P=0.01 by a two-sided log-rank test stratified according to nodal status, prior adjuvant chemotherapy, the interval from the last dose of aromatase-inhibitor therapy, and the duration of treatment with tamoxifen). The rate of 5-year overall survival was 93% (95% CI, 92 to 95) with letrozole and 94% (95% CI, 92 to 95) with placebo (hazard ratio, 0.97; P=0.83). The annual incidence rate of contralateral breast cancer in the letrozole group was 0.21% (95% CI, 0.10 to 0.32), and the rate in the placebo group was 0.49% (95% CI, 0.32 to 0.67) (hazard ratio, 0.42; P=0.007). Bone-related toxic effects occurred more frequently among patients receiving letrozole than among those receiving placebo, including a higher incidence of bone pain, bone fractures, and new-onset osteoporosis. No significant differences between letrozole and placebo were observed in scores on most subscales measuring quality of life. CONCLUSIONS The extension of treatment with an adjuvant aromatase inhibitor to 10 years resulted in significantly higher rates of disease-free survival and a lower incidence of contralateral breast cancer than those with placebo, but the rate of overall survival was not higher with the aromatase inhibitor than with placebo. (Funded by the Canadian Cancer Society and others; ClinicalTrials.gov numbers, NCT00003140 and NCT00754845.).
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Affiliation(s)
- Paul E Goss
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - James N Ingle
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kathleen I Pritchard
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Nicholas J Robert
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Hyman Muss
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Julie Gralow
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Karen Gelmon
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Tim Whelan
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kathrin Strasser-Weippl
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Sheldon Rubin
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Keren Sturtz
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Antonio C Wolff
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Eric Winer
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Clifford Hudis
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Alison Stopeck
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - J Thaddeus Beck
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Judith S Kaur
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kate Whelan
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Dongsheng Tu
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Wendy R Parulekar
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
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Goss PE, Ingle JN, Pritchard KI, Robert NJ, Muss H, Gralow J, Gelmon K, Whelan T, Strasser-Weippl K, Rubin S, Sturtz K, Wolff AC, Winer E, Hudis C, Stopeck A, Beck JT, Kaur JS, Whelan K, Tu D, Parulekar WR. Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. N Engl J Med 2016; 375:209-19. [PMID: 27264120 PMCID: PMC5024713 DOI: 10.1056/nejmoa1604700] [Citation(s) in RCA: 425] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment with an aromatase inhibitor for 5 years as up-front monotherapy or after tamoxifen therapy is the treatment of choice for hormone-receptor-positive early breast cancer in postmenopausal women. Extending treatment with an aromatase inhibitor to 10 years may further reduce the risk of breast-cancer recurrence. METHODS We conducted a double-blind, placebo-controlled trial to assess the effect of the extended use of letrozole for an additional 5 years. Our primary end point was disease-free survival. RESULTS We enrolled 1918 women. After a median follow-up of 6.3 years, there were 165 events involving disease recurrence or the occurrence of contralateral breast cancer (67 with letrozole and 98 with placebo) and 200 deaths (100 in each group). The 5-year disease-free survival rate was 95% (95% confidence interval [CI], 93 to 96) with letrozole and 91% (95% CI; 89 to 93) with placebo (hazard ratio for disease recurrence or the occurrence of contralateral breast cancer, 0.66; P=0.01 by a two-sided log-rank test stratified according to nodal status, prior adjuvant chemotherapy, the interval from the last dose of aromatase-inhibitor therapy, and the duration of treatment with tamoxifen). The rate of 5-year overall survival was 93% (95% CI, 92 to 95) with letrozole and 94% (95% CI, 92 to 95) with placebo (hazard ratio, 0.97; P=0.83). The annual incidence rate of contralateral breast cancer in the letrozole group was 0.21% (95% CI, 0.10 to 0.32), and the rate in the placebo group was 0.49% (95% CI, 0.32 to 0.67) (hazard ratio, 0.42; P=0.007). Bone-related toxic effects occurred more frequently among patients receiving letrozole than among those receiving placebo, including a higher incidence of bone pain, bone fractures, and new-onset osteoporosis. No significant differences between letrozole and placebo were observed in scores on most subscales measuring quality of life. CONCLUSIONS The extension of treatment with an adjuvant aromatase inhibitor to 10 years resulted in significantly higher rates of disease-free survival and a lower incidence of contralateral breast cancer than those with placebo, but the rate of overall survival was not higher with the aromatase inhibitor than with placebo. (Funded by the Canadian Cancer Society and others; ClinicalTrials.gov numbers, NCT00003140 and NCT00754845.).
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Affiliation(s)
- Paul E Goss
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - James N Ingle
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kathleen I Pritchard
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Nicholas J Robert
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Hyman Muss
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Julie Gralow
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Karen Gelmon
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Tim Whelan
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kathrin Strasser-Weippl
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Sheldon Rubin
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Keren Sturtz
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Antonio C Wolff
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Eric Winer
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Clifford Hudis
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Alison Stopeck
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - J Thaddeus Beck
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Judith S Kaur
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Kate Whelan
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Dongsheng Tu
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
| | - Wendy R Parulekar
- From the Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program (P.E.G.), Harvard Medical School (P.E.G., E.W.), and Dana-Farber Cancer Institute (E.W.), Boston; the Department of Oncology, Mayo Clinic, Rochester, MN (J.N.I., J.S.K.); Sunnybrook Odette Cancer Centre, Toronto (K.I.P.), British Columbia Cancer Agency, Vancouver (K.G.), Canadian Cancer Trials Group, Queen's University, Kingston, ON (K.W., D.T., W.R.P.), Department of Oncology, McMaster University, Hamilton, ON (T.W.), and Dalhousie University Faculty of Medicine, Moncton Hospital, Moncton, NB (S.R.) - all in Canada; Virginia Cancer Specialists-US Oncology Network, Fairfax (N.J.R.); University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill (H.M.); University of Washington School of Medicine, Seattle (J.G.); Center of Oncology and Hematology, Wilheminen Hospital, Vienna (K.S.-W.); Colorado Cancer Research Program, Denver (K.S.); Johns Hopkins Kimmel Cancer Center, Baltimore (A.C.W.); Memorial Sloan Kettering Cancer Center, New York (C.H.); University of Arizona, Tucson (A.S.); and Highlands Oncology Group, Fayetteville, AR (J.T.B.)
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7
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Factors associated with late recurrence after completion of 5-year adjuvant tamoxifen in estrogen receptor positive breast cancer. BMC Cancer 2016; 16:430. [PMID: 27388210 PMCID: PMC4937609 DOI: 10.1186/s12885-016-2423-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent large trials have shown the survival benefits of 10-year use of tamoxifen by reducing late recurrence compared with 5-year therapy in estrogen receptor(ER)-positive breast cancer. We tried to identify clinical factors associated with the late recurrence. METHODS We reviewed our database of ER-positive patients who had received operations between 1996 and 2006 in two institutions. We selected 444 who had completed 5-year tamoxifen and were disease-free up to 10 years after the operation. Patients who had received aromatase inhibitors with any regimens were excluded. As a late recurrence group, 139 patients were identified who had completed 5-year tamoxifen, but had recurrence afterwards. Among them, 61 had local/contralateral breast recurrence and 78 had distant metastasis. The median follow-up was 9.7 years. Clinicopathological factors at the time of initial operation, such as age, menopausal status, progesterone receptor expression, HER2 status, tumor grade and Ki-67, were compared between the disease-free group and the late recurrence group. RESULTS In a univariate analysis, tumor size (>2 cm), lymph node metastasis and high histologic grade were significantly associated with late recurrences (p < 0.05). In a multivariate analysis, only axillary lymph node metastasis was significant (p < 0.001). Late distant metastasis was significantly associated with tumor size and axillary lymph node metastasis (p = 0.038, p < 0.001,respectively). Late local/contralateral breast recurrence was associated with axillary lymph node metastasis (p = 0.042). CONCLUSIONS Our data showed axillary lymph node metastasis at initial operation was the only risk factor of late recurrence after completion of tamoxifen for 5 years. Our results can be helpful in making decisions to use extended tamoxifen beyond 5 years.
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8
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Gregory WM, Twelves CJ, Bell R, Smye SW, Howard DR, Coleman RE, Cameron DA. Characterizing and quantifying the effects of breast cancer therapy using mathematical modeling. Breast Cancer Res Treat 2016; 155:303-11. [PMID: 26783036 PMCID: PMC4729810 DOI: 10.1007/s10549-016-3684-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/07/2016] [Indexed: 01/13/2023]
Abstract
We designed a mathematical model to describe and quantify the mechanisms and dynamics of tumor growth, cell-kill and resistance as they affect durations of benefit after cancer treatment. Our aim was to explore how treatment efficacy may be related to primary tumor characteristics, with the potential to guide future trial design and appropriate selection of therapy. Assuming a log-normal distribution of both resistant disease and tumor doubling times generates disease-free survival (DFS) or invasive DFS curves with specific shapes. Using a multivariate mathematical model, both treatment and tumor characteristics are related to quantified resistant disease and tumor regrowth rates by allowing different mean values for the influence of different treatments or clinical subtypes on these two log-normal distributions. Application of the model to the CALGB 9741 adjuvant breast cancer trial showed that dose-dense therapy was estimated to achieve an extra 3/4 log of cell-kill compared to standard therapy, but only in patients with more rapidly growing ER-negative tumors. Application of the model to the AZURE trial of adjuvant bisphosphonate treatment suggested that the 5-year duration of zoledronic acid was adequate for ER-negative tumors, but may not be so for ER-positive cases, with increased recurrences after ceasing the intervention. Mathematical models can identify different effects of treatment by subgroup and may aid in treatment design, trial analysis, and appropriate selection of therapy. They may provide a more appropriate and insightful tool than the conventional Cox model for the statistical analysis of response durations.
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Affiliation(s)
- Walter M Gregory
- Leeds Institute for Clinical Trials Research (LICTR), University of Leeds, Clinical Trials Research House, 71-75 Clarendon Road, Leeds, LS2 9JT, UK.
| | | | | | - Stephen W Smye
- St. James's Academic Division of Medical Physics, University of Leeds, Leeds, UK
| | - Dena R Howard
- Leeds Institute for Clinical Trials Research (LICTR), University of Leeds, Clinical Trials Research House, 71-75 Clarendon Road, Leeds, LS2 9JT, UK
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9
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The impact of Anastrazole and Letrozole on the metabolic profile in an experimental animal model. Sci Rep 2015; 5:17493. [PMID: 26620133 PMCID: PMC4664924 DOI: 10.1038/srep17493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/30/2015] [Indexed: 01/22/2023] Open
Abstract
Anastrazole and Letrozole are used as endocrine therapy for breast cancer patients. Previous studies suggested a possible association with metabolic and liver adverse effects. Their results are conflicting. Fifty-five 4-week-old female Wistar rats were allocated in 4 groups 1) ovariectomy control (OC), 2) ovariectomy-Anastrazole (OA) 3) ovariectomy -Letrozole (OL), 4) control. Serum glucose, cholesterol, triglycerides, HDL-c and LDL-c were measured at baseline, 2 and 4 months. At the end, the animals' liver were dissected for pathology. At 4 months, total cholesterol differed among the OC and OL groups (p = 0.15) and the control and OL groups (p = 0.12). LDL-C differed between the control and OC groups (p = 0.015) as well as between the control and OA (p =0 .015) and OL groups (p = 0.002). OC group triglycerides, differed from those of the OL group (p =0 .002) and the control group (p = 0.007). The OA also significantly differed from the OL (p = 0.50). Liver pathology analysis revealed differences among groups with favored mild steatosis and ballooning. Anastrazole and Letrozole seem to negatively influence the lipid profile in our experimental model. This information should be taken in caution by medical oncologists when addressing patients with altered lipid metabolism.
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10
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Walter W, Thomalla J, Bruhn J, Fagan DH, Zehowski C, Yee D, Skildum A. Altered regulation of PDK4 expression promotes antiestrogen resistance in human breast cancer cells. SPRINGERPLUS 2015; 4:689. [PMID: 26576332 PMCID: PMC4641142 DOI: 10.1186/s40064-015-1444-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022]
Abstract
Acquired or de novo resistance to the selective estrogen receptor modulators tamoxifen and fulvestrant (ICI) is a major barrier to successful treatment of breast cancer. Gene expression patterns in tamoxifen resistant (TamR-MCF-7) cells were compared to their parental cells (MCF-7L) to identify an aberrantly regulated metabolic pathway. TamR-MCF-7 cells are cross resistant to ICI and doxorubicin, and have increased mitochondrial DNA. A small subset of genes had altered expression in TamR-MCF-7 relative to MCF-7L cells. One of the genes, pyruvate dehydrogenase kinase-4 (PDK4), phosphorylates pyruvate dehydrogenase (PDH). PDK4 expression was elevated in TamR-MCF-7 cells; this result was also observed in a second model of acquired antiestrogen resistance. PDK4 expression is controlled in part by glucocorticoid response elements in the PDK4 gene promoter. In MCF-7L cells, PDK4 mRNA expression was insensitive to glucocorticoid receptor agonists, while dexamethasone dramatically increased PDK4 expression in TamR-MCF-7 cells. Using siRNA to knock down PDK4 expression increased TamR-MCF-7 sensitivity to ICI; in contrast adapting cells to growth in glucose depleted media did not affect ICI sensitivity. Despite TamR-MCF-7 cells high levels of PDK4 mRNA relative to MCF-7L, TamR-MCF-7 cells have increased PDH activity. Wild type MCF-7 cells are reported to be heterozygous for a G to A mutation that results in a substitution of threonine for alanine near PDK4′s catalytic site. We found loss of heterozygosity in TamR-MCF-7 cells; TamR-MCF-7 are homozygous for the wild type allele. These data support a role for altered regulation of PDH by PDK4 and altered substrate utilization in the development of drug resistance in human breast cancer cells.
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Affiliation(s)
- William Walter
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN USA
| | - Jennifer Thomalla
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN USA
| | - Josh Bruhn
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN USA
| | - Dedra H Fagan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Cheryl Zehowski
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN USA
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Andrew Skildum
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN USA ; Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
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11
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Nardone A, De Angelis C, Trivedi MV, Osborne CK, Schiff R. The changing role of ER in endocrine resistance. Breast 2015; 24 Suppl 2:S60-6. [PMID: 26271713 DOI: 10.1016/j.breast.2015.07.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Estrogen receptor (ER) is expressed in approximately 70% of newly diagnosed breast tumors. Although endocrine therapy targeting ER is highly effective, intrinsic or acquired resistance is common, significantly jeopardizing treatment outcomes and minimizing overall survival. Even in the presence of endocrine resistance, a continued role of ER signaling is suggested by several lines of clinical and preclinical evidence. Indeed, inhibition or down-regulation of ER reduces tumor growth in preclinical models of acquired endocrine resistance, and many patients with recurrent ER+ breast tumors progressing on one type of ER-targeted treatment still benefit from sequential endocrine treatments that target ER by a different mechanism. New insights into the nature and biology of ER have revealed several mechanisms sustaining altered ER signaling in endocrine-resistant tumors, including deregulated growth factor receptor signaling that results in ligand-independent ER activation, unbalanced ER co-regulator activity, and genomic alterations involving the ER gene ESR1. Therefore, biopsies of recurrent lesions are needed to assess the changes in epi/genomics and signaling landscape of ER and associated pathways in order to tailor therapies to effectively overcome endocrine resistance. In addition, more completely abolishing the levels and activity of ER and its co-activators, in combination with selected signal transduction inhibitors or agents blocking the upstream or downstream targets of the ER pathway, may provide a better therapeutic strategy in combating endocrine resistance.
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Affiliation(s)
- Agostina Nardone
- Lester and Sue Smith Breast Center, Baylor College of Medicine, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, USA; Department of Medicine, Baylor College of Medicine, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, USA
| | - Carmine De Angelis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, USA; Department of Medicine, Baylor College of Medicine, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, USA; Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Italy
| | - Meghana V Trivedi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, USA; Department of Medicine, Baylor College of Medicine, USA; Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Houston, TX 77030, USA
| | - C Kent Osborne
- Lester and Sue Smith Breast Center, Baylor College of Medicine, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, USA; Department of Medicine, Baylor College of Medicine, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, USA
| | - Rachel Schiff
- Lester and Sue Smith Breast Center, Baylor College of Medicine, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, USA; Department of Medicine, Baylor College of Medicine, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, USA.
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12
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The UZ Leuven Policy for Extended Adjuvant Anti-estrogen Therapy in Women With Early Estrogen Receptor-Positive Breast Cancer. Curr Treat Options Oncol 2015; 16:31. [PMID: 26031545 DOI: 10.1007/s11864-015-0349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Opinion statement: Five years after adjuvant endocrine treatment for estrogen receptor (ER)-positive breast cancer, patients have a 2 to 20 % risk of metastatic relapse during the next 5 years. Extended adjuvant endocrine therapy seems to further lower this. In UZ Leuven, extended endocrine therapy is now discussed unless the tumor was a grade 1-2, pT1N0, ER-positive, progesterone receptor (PR)-positive, HER2-negative lesion. After 5 years of adjuvant tamoxifen treatment for ER-positive breast cancer, we encourage women to take another 5 years of tamoxifen. If the tumor was lymph node-positive at diagnosis and patients are menopausal after the first 5 years of tamoxifen, we advise to take prolonged treatment with an oral aromatase inhibitor (AI). For this particular group, available data for extending endocrine therapy with an AI after 5 years of tamoxifen are strongest and more convincing for letrozole than for anastrozole or exemestane. Under these conditions, letrozole is reimbursed for 3 years in Belgium. If women are postmenopausal at diagnosis and already used an oral AI at any time during the first 5 years, we discuss an extra 5 years of tamoxifen. Results from ongoing clinical trials will tell us whether in these cases prolonged AI use is better than tamoxifen so that therapy can be adapted. Benefit from extended adjuvant endocrine therapy is likely larger with better compliance and potential side effects of extended endocrine therapy need to be discussed. Therefore, when advising extended adjuvant endocrine treatment, a balance should always be made between relapse risk and treatment tolerance/compliance.
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13
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Järvensivu P, Saloniemi-Heinonen T, Awosanya M, Koskimies P, Saarinen N, Poutanen M. HSD17B1 expression enhances estrogen signaling stimulated by the low active estrone, evidenced by an estrogen responsive element-driven reporter gene in vivo. Chem Biol Interact 2015; 234:126-34. [DOI: 10.1016/j.cbi.2015.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 01/13/2023]
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14
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Extended adjuvant endocrine therapy in hormone-receptor positive early breast cancer: Current and future evidence. Cancer Treat Rev 2015; 41:271-6. [DOI: 10.1016/j.ctrv.2015.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 12/20/2022]
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15
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Daniel B, Mitchell H, Higham P, Timpson J, Foy S. Management of Menopausal Symptoms for Breast Cancer Patients. ACTA ACUST UNITED AC 2014; 23:427-32. [DOI: 10.12968/bjon.2014.23.8.427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Philip Higham
- Specialist Clinical Audit Facilitator, The Christie Hospital, Manchester
| | - Joanne Timpson
- is Lecturer in Nursing and Academic Lead for Student Experience, Manchester University
| | - Sharon Foy
- Macmillan Breast Clinical Nurse Specialist, The Christie Hospital, Manchester
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Natoli C, Brocco D, Sperduti I, Nuzzo A, Tinari N, De Tursi M, Grassadonia A, Mazzilli L, Iacobelli S, Gamucci T, Vici P. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One 2014; 9:e94063. [PMID: 24714591 PMCID: PMC3979748 DOI: 10.1371/journal.pone.0094063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called “tailored follow-up”, high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.
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Affiliation(s)
- Clara Natoli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
- * E-mail:
| | - Davide Brocco
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Isabella Sperduti
- Unit of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Nuzzo
- Oncology Department, “Floraspe Renzetti” Hospital, Lanciano, Italy
| | - Nicola Tinari
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Michele De Tursi
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Antonino Grassadonia
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Lorenzo Mazzilli
- Clinical Governance Unit, “SS. Annunziata” Hospital, Chieti, Italy
| | - Stefano Iacobelli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Teresa Gamucci
- Department of Oncology, “S.S. Trinita′” Hospital, Sora, Italy
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
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