Which endocrine therapy regimen would result in highest (or best) disease-free survival in a 32 year old women one year out from a pT2, pN1, ER positive, HER2 negative invasive ductal carcinoma of the right breast?

  • The Tamoxifen and Exemestane Trial (TEXT) and the Suppression of Ovarian Function Trial (SOFT):
    • Investigated adjuvant endocrine therapies:
      • For premenopausal women:
        • With hormone receptor-positive breast cancer
  • Randomizing women to:
    • Exemestane plus ovarian function suppression (OFS)
    • Tamoxifen plus OFS
    • Tamoxifen alone:
      • For 5 years
  • The studies were combined for primary analysis:
    • After enrolling:
      • 4690 patients
    • After a median follow-up of:
      • 68 months:
        • DFS was:
          • 91.1% in the exemestane-ovarian suppression arm versus
          • 87.3% in the tamoxifen-ovarian suppression arm
            • p<0.001
    • Overall survival:
      • Did not differ between the groups
    • Adverse events were reported for:
      • 30.6% of exemestane-ovarian suppression patients and
      • 29.4% of tamoxifen-ovarian suppression group
  • Women on an aromatase inhibitor or who experience ovarian failure secondary to treatment:
    • Should have monitoring of bone health:
      • With a bone mineral density scan:
        • At baseline and periodically thereafter
  • The use of estrogen, progesterone, or selective ER modulators:
    • To treat osteoporosis or osteopenia in women with breast cancer:
      • Is discouraged
    • The use of a bisphosphonate:
    • Is generally the preferred intervention:
      • To improve bone mineral density
        • Optimal duration of bisphosphonate therapy:
          • Has not been established:
            • Factors to consider for duration of anti-osteoporosis therapy include:
              • Bone mineral density
              • Response to therapy
              • Risk factors for continued bone loss or fracture
    • Women treated with a bisphosphonate:
      • Should undergo a dental examination with preventive dentistry prior to the initiation of therapy, and
      • Should take supplemental calcium and vitamin D
  • References:
    • Pagani O, Regan MM, Walley BA, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014;371(2):107-118.
    • Wilkinson GS, Kuo Y-F, Freeman JL, Goodwin JS. Intravenous bisphosphonate therapy and inflammatory conditions or surgery of the jaw: a population-based analysis. J Natl Cancer Inst. 2007;99(13):1016-1024.
    • Regan MM, Francis PA, Pagani O, et al. Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT Trials. J Clin Oncol. 2016;34(19):2221-2231.

#Arrangoiz #Surgeon #BreastCancer #CancerSurgeon #SurgicalOncologist

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