scholarly journals American Society of Clinical Oncology Clinical Practice Guideline Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer

2010 ◽  
Vol 6 (5) ◽  
pp. 243-246 ◽  
Author(s):  
Harold J. Burstein ◽  
Jennifer J. Griggs ◽  
Ann A. Prestrud ◽  
Sarah Temin
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Aromatase Inhibitors ◽  
Clinical Practice Guideline ◽  
Technology Assessment ◽  
Practice Guideline ◽  
Adjuvant Setting ◽  
Hormone Receptor Positive ◽  
American Society ◽  
Positive Breast Cancer

ASCO's technology assessment of the use of aromatase inhibitors in the adjuvant setting was last updated in 2004. ASCO's Update Committee on Aromatase Inhibitors reconvened in May 2009 to update this guideline.

American Society of Clinical Oncology Technology Assessment on the Use of Aromatase Inhibitors as Adjuvant Therapy for Women With Hormone Receptor–Positive Breast Cancer: Status Report 2002

2002 ◽  
Vol 20 (15) ◽  
pp. 3317-3327 ◽  
Author(s):  
Eric P. Winer ◽  
Clifford Hudis ◽  
Harold J. Burstein ◽  
Rowan T. Chlebowski ◽  
James N. Ingle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Oncology ◽  
Aromatase Inhibitors ◽  
Technology Assessment ◽  
Hormone Receptor ◽  
Status Report ◽  
Care Providers ◽  
Hormone Receptor Positive ◽  
American Society ◽  
Positive Breast Cancer

OBJECTIVE: To conduct an evidence-based technology assessment to determine whether the routine use of anastrozole or any of the aromatase inhibitors in the adjuvant breast cancer setting is appropriate for broad-based conventional use in clinical practice. POTENTIAL INTERVENTIONS: Anastrozole, letrozole, and exemestane. OUTCOMES: Outcomes of interest include breast cancer incidence, breast cancer-specific survival, overall survival, and net health benefit. EVIDENCE: A comprehensive, formal literature review was conducted for relevant topics and is detailed in the text. Testimony was collected from invited experts and interested parties. The American Society of Clinical Oncology (ASCO)–prescribed technology assessment procedure was followed. BENEFITS/HARMS: The ASCO panel recognizes that a woman and her physician’s decision regarding adjuvant hormonal therapy is complex and will depend on the importance and weight attributed to information regarding both cancer and non–cancer-related risks and benefits. CONCLUSION: The panel was influenced by the compelling, extensive, and long-term data available on tamoxifen. Overall, the panel considers the results of the Arimidex (anastrozole) or Tamoxifen Alone or in Combination (ATAC) trial and the extensive supporting data to be very promising but insufficient to change the standard practice at this time (May 2002). A 5-year course of adjuvant tamoxifen remains the standard therapy for women with hormone receptor–positive breast cancer. The panel recommends that physicians discuss the available information with patients, and, in making a decision, acknowledge that treatment approaches can change over time. Individual health care providers and their patients will need to come to their own conclusions, with careful consideration of all of the available data. (Specific questions addressed by the panel are summarized in Appendix 3.) VALIDATION: The conclusions of the panel were endorsed by the ASCO Health Services Research Committee and the ASCO Board of Directors. SPONSOR: American Society of Clinical Oncology.

scholarly journals Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update

2014 ◽  
Vol 32 (21) ◽  
pp. 2255-2269 ◽  
Author(s):  
Harold J. Burstein ◽  
Sarah Temin ◽  
Holly Anderson ◽  
Thomas A. Buchholz ◽  
Nancy E. Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Aromatase Inhibitor ◽  
Endocrine Therapy ◽  
Clinical Practice Guideline ◽  
Adjuvant Endocrine Therapy ◽  
Tamoxifen Treatment ◽  
Adjuvant Tamoxifen ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

PurposeTo update the ASCO clinical practice guideline on adjuvant endocrine therapy on the basis of emerging data on the optimal duration of treatment, particularly adjuvant tamoxifen.MethodsASCO convened the Update Committee and conducted a systematic review of randomized clinical trials from January 2009 to June 2013 and analyzed three historical trials. Guideline recommendations were based on the Update Committee's review of the evidence. Outcomes of interest included survival, disease recurrence, and adverse events.ResultsThis guideline update reflects emerging data on duration of tamoxifen treatment. There have been five studies of tamoxifen treatment beyond 5 years of therapy. The two largest studies with longest reported follow-up show a breast cancer survival advantage with 10-year durations of tamoxifen use. In addition to modest gains in survival, extended therapy with tamoxifen for 10 years compared with 5 years was associated with lower risks of breast cancer recurrence and contralateral breast cancer.RecommendationsPrevious ASCO guidelines recommended treatment of women who have hormone receptor–positive breast cancer and are premenopausal with 5 years of tamoxifen, and those who are postmenopausal a minimum of 5 years of adjuvant therapy with an aromatase inhibitor or tamoxifen followed by an aromatase inhibitor (in sequence). If women are pre- or perimenopausal and have received 5 years of adjuvant tamoxifen, they should be offered 10 years total duration of tamoxifen. If women are postmenopausal and have received 5 years of adjuvant tamoxifen, they should be offered the choice of continuing tamoxifen or switching to an aromatase inhibitor for 10 years total adjuvant endocrine therapy.

Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update

2019 ◽  
Vol 37 (5) ◽  
pp. 423-438 ◽  
Author(s):  
Harold J. Burstein ◽  
Christina Lacchetti ◽  
Holly Anderson ◽  
Thomas A. Buchholz ◽  
Nancy E. Davidson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Endocrine Therapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Cancer Recurrence ◽  
Endocrine Treatment ◽  
Breast Cancers ◽  
Node Negative ◽  
Positive Breast Cancer

Purpose To update the ASCO clinical practice guideline on adjuvant endocrine therapy based on emerging data about the optimal duration of aromatase inhibitor (AI) treatment. Methods ASCO conducted a systematic review of randomized clinical trials from 2012 to 2018. Guideline recommendations were based on the Panel’s review of the evidence from six trials. Results The six included studies of AI treatment beyond 5 years of therapy demonstrated that extension of AI treatment was not associated with an overall survival advantage but was significantly associated with lower risks of breast cancer recurrence and contralateral breast cancer compared with placebo. Bone-related toxic effects were more common with extended AI treatment. Recommendations The Panel recommends that women with node-positive breast cancer receive extended therapy, including an AI, for up to a total of 10 years of adjuvant endocrine treatment. Many women with node-negative breast cancer should consider extended therapy for up to a total of 10 years of adjuvant endocrine treatment based on considerations of recurrence risk using established prognostic factors. The Panel noted that the benefits in absolute risk of reduction were modest and that, for lower-risk node-negative or limited node-positive cancers, an individualized approach to treatment duration that is based on considerations of risk reduction and tolerability was appropriate. A substantial portion of the benefit for extended adjuvant AI therapy was derived from prevention of second breast cancers. Shared decision making between clinicians and patients is appropriate for decisions about extended adjuvant endocrine treatment, including discussions about the absolute benefits in the reduction of breast cancer recurrence, the prevention of second breast cancers, and the impact of adverse effects of treatment. Additional information can be found at www.asco.org/breast-cancer-guidelines .

The Aromatase Inhibitors as Adjuvant Therapy for Hormone Receptor-Positive Breast Cancer

2003 ◽  
Vol 1 (2) ◽  
pp. 215-221
Author(s):  
Jennifer A. Ligibel ◽  
Eric P. Winer
Keyword(s):  
Breast Cancer ◽  
Aromatase Inhibitors ◽  
Hormonal Therapy ◽  
Hormone Receptor ◽  
Uterine Cancer ◽  
Adjuvant Hormonal Therapy ◽  
Adjuvant Setting ◽  
Modest Improvement ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

Adjuvant hormonal therapy has been shown to decrease the risk of breast cancer recurrence and overall mortality in patients with hormone receptor-positive breast cancer. Tamoxifen has been used in this setting for many years, both in premenopausal and postmenopausal patients. Tamoxifen is not devoid of toxicity, and attempts have been made to develop newer hormonal agents with better efficacy and less toxicity. The aromatase inhibitors have shown equivalent or superior efficacy to tamoxifen in the treatment of metastatic breast cancer, and efforts are underway to determine the role of these agents in early breast cancer. The ATAC trial recently showed that use of the third-generation aromatase inhibitor anastrozole in the adjuvant setting led to a modest improvement in relapse-free survival as compared with tamoxifen. Patients treated with anastrozole were also less likely to develop uterine cancer or experience a thromboembolic event. However, patients treated with anastrozole were more likely than those treated with tamoxifen to suffer a fracture or other musculosketal problem. An ASCO technology assessment panel reviewed the relevant data and issued a consensus statement regarding the use of aromatase inhibitors in the adjuvant setting. In general, the panel favored the continued use of tamoxifen as adjuvant hormonal therapy for most postmenopausal women. Within the next few years, further data from the ATAC trial and from other trials of aromatase inhibitors in the adjuvant setting should be available to guide treatment recommendations for this patient population.

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