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Controversies in Adjuvant Endocrine Therapy for Breast Cancer

Summaries of Lectures From a Satellite Symposium Held in Conjunction With the 30th Annual San Antonio Breast Cancer Symposium; San Antonio, TX; December 13-16, 2007

1 AMA PRA Category 1 Credit^™

Release date: April 25, 2008
Expiration date: April 25, 2009

Table of Contents
Adjuvant Endocrine Therapy in 2007: What Have We Accomplished and What Uncertainties Remain?
Kathleen Pritchard, MD, FRCP(C)

Optimizing Endocrine Therapy for Patients With Newly Diagnosed Early-Stage Breast Cancer
Alan Coates, MD, FRACP, Astat, AM
Harold Burstein, MD, PhD

Controversies in Adjuvant Endocrine Therapy: Extending Therapy Beyond 5 Years
James N. Ingle, MD
Matthew Ellis, MB BChir, PhD, FRCP

Should All Patients Receiving Adjuvant Aromatase Inhibitors for Breast Cancer Receive Bisphosphonate Support?
Adam Brufsky, MD, PhD
Julie Gralow, MD

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Adjuvant endocrine therapy significantly improves the outcome for patients with hormone receptor–positive early-stage breast cancer, and the recent introduction of aromatase inhibitors (AIs) for postmenopausal patients in this setting has led to further improvements. However, many questions remain concerning the optimal use of these powerful therapeutic tools. Debate continues concerning the optimal treatment strategy: up-front administration of these agents in place of tamoxifen or switching to an AI following 2-3 years of tamoxifen. In addition, the question has been raised whether 5 years of adjuvant endocrine therapy affords maximum benefit to patients or if an extended course of these agents beyond 5 years could further reduce the relative risk of recurrence. These issues must also be considered with regard to the comparative toxicity profiles of the available endocrine therapy regimens and whether supportive therapy measures using bisphosphonates are warranted for all patients receiving AIs to attenuate bone-related adverse events. Despite the significant clinical benefits resulting from the use of adjuvant endocrine therapy for the treatment of hormone receptor–positive breast cancer, further research and careful analyses of existing data are still needed to optimize efficacy while reducing treatment-related side effects for patients in this setting.

The purpose of this activity is to apprise physicians of current data on the use of adjuvant endocrine therapy and to highlight key points of controversy regarding their optimal use in treatment regimens for hormone receptor–positive breast cancer.

• Assess data from clinical trials evaluating switching treatment to an AI following tamoxifen compared to up-front treatment with an AI in early-stage breast cancer
• Discuss the risks and benefits of extending adjuvant endocrine therapy beyond 5 years of tamoxifen in patients with estrogen receptor–positive early-stage breast cancer
• Evaluate the efficacy and safety of bisphosphonates in preventing bone loss and fractures in patients receiving adjuvant endocrine therapy for breast cancer

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PER Editorial Staff

No relevant relationships to disclose

Satellite Faculty

Adam Brufsky, MD, PhD
No relevant relationships to disclose

Harold Burstein, MD, PhD
No relevant relationships to disclose

Alan Coates, MD, FRACP, Astat, AM
No relevant relationships to disclose

Matthew Ellis, MB BChir, PhD, FRCP
Research Funding – AstraZeneca, Novartis Pharmaceuticals Corporation
Paid Consultant – AstraZeneca, Genentech, Inc., GlaxoSmithKline, and Novartis Pharmaceutical Corporation
Member of Speaker’s Bureau – GlaxoSmithKline

Julie Gralow, MD
Research Funding – Amgen, Bristol-Myers Squibb Company, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Roche Pharmaceuticals, and sanofi-aventis U.S.

James N. Ingle, MD
Paid Consultant – Novartis Pharmaceuticals Corporation

Kathleen Pritchard, MD, FRCP(C)
Paid Consultant – AstraZeneca, Bayer Pharmaceuticals Corporation, Novartis Pharmaceuticals Corporation, Pfizer Inc., and Roche Pharmaceuticals

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An educational grant for this activity was provided by Novartis Oncology.

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Editor, Controversies in Adjuvant Endocrine Therapy for Breast Cancer
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