Abstract | PURPOSE: METHODS: We developed Markov models to simulate 10-year disease-free survival among postmenopausal women with hormone receptor-positive breast cancer. The treatment strategies analyzed were 5 years of tamoxifen alone, 5 years of an aromatase inhibitor alone, and sequential treatment consisting of tamoxifen with cross over to an aromatase inhibitor at 2.5 or 5 years. Risk estimates were derived from reported randomized clinical trials. RESULTS: Sequential therapy with tamoxifen followed by cross over to an aromatase inhibitor at 2.5 years yielded a modest improvement in disease-free survival compared with planned aromatase inhibitor monotherapy. At 10 years, the cross-over strategy yielded absolute disease-free survival rates of 83.7% and 67.6% for node-negative and node-positive patients, respectively, compared with 82.6% and 65.5%, respectively, for aromatase inhibitor monotherapy, which is a 6% relative risk reduction. Sequential therapy improved disease-free survival estimates by year 6 after treatment initiation. Later cross over from tamoxifen to an aromatase inhibitor at 5 years did not further improve 10-year disease-free survival estimates. Sensitivity analyses suggest that sequential treatment strategies optimized 10-year disease-free and distant disease-free survival independent of the degree of the beneficial carryover effect after aromatase inhibitor therapy or the ratio of local to distant tumor recurrence. CONCLUSION:
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Authors | Rinaa S Punglia, Karen M Kuntz, Eric P Winer, Jane C Weeks, Harold J Burstein |
Journal | Journal of clinical oncology : official journal of the American Society of Clinical Oncology
(J Clin Oncol)
Vol. 23
Issue 22
Pg. 5178-87
(Aug 01 2005)
ISSN: 0732-183X [Print] United States |
PMID | 15998905
(Publication Type: Journal Article)
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Chemical References |
- Antineoplastic Agents, Hormonal
- Aromatase Inhibitors
- Tamoxifen
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Topics |
- Aged
- Antineoplastic Agents, Hormonal
(therapeutic use)
- Aromatase Inhibitors
(therapeutic use)
- Breast Neoplasms
(drug therapy, pathology, surgery)
- Chemotherapy, Adjuvant
- Decision Support Techniques
- Disease-Free Survival
- Drug Administration Schedule
- Female
- Humans
- Markov Chains
- Middle Aged
- Postmenopause
- Tamoxifen
(therapeutic use)
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