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FRANCESCO BOCCARDO. INIBITORI DELL’AROMATASI. (back from San Antonio). Professore Ordinario di Oncologia Medica, Università di Genova. Direttore Oncologia Medica B IST .Genova. Presidente Nazionale Associazione Italiana Oncologia Medica. Decision Points. Tamoxifen. Aromatase inhibitor.
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FRANCESCO BOCCARDO INIBITORI DELL’AROMATASI (back from San Antonio) Professore Ordinario di Oncologia Medica, Università di Genova Direttore Oncologia Medica BIST .Genova Presidente Nazionale Associazione Italiana Oncologia Medica
Decision Points Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years 1 ? ? 4 3 ? 2 3 ? ? ? 4
Decision Points:after 2-3 yrs of Tam IES ABCSG8/ARNO95 ITA ? 1 Tamoxifen ? Aromatase inhibitor 5 years total 10 years total > 10 years
……….back from San Antonio 2008: take home #1 “There is a clear benefit (including a S benefit) in switching women already on treatment with Tam to an AI (anastrozole,exemestane) unless AI therapy is contraindicated”
Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years Decision Points: Initial choice ? ? ATAC BIG 1-98 monotherapy TEAM 2.75 yr 2 ? ? ?
……….back from San Antonio 2008: take home #2 Which drug or which patients?”
Predicting the benefit and the risks. Tamoxifen vs Ais: Tumor Profile ERPgR HER2 Recurrence Score Cyclin E uPA/uPAI-1 Bcl-2 ER-beta Patient Profile Osteoporosis Hypercholesterolemia CV risk factors Endometrial pathologies DVT & TE risk factors SSRI use CYP 19 Genotype CYP2D6 Genotype
……….back from San Antonio 2008: take home #3 Starting with an Ai is a reasonable choice especially in certain patient subsets (i.e. PgRneg,HER2 pos,HRScore Node neg,poor metabolizers of CYP2D6….!):however: 1) no major survival advantge yet 2) No over rate in selecting patients
Decision Points:sequencing Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years 1 ? ? 4 3 ABCSG8 TEAM 5-yr: n.a. yet ? 2 3 BIG-1-98 ? ? ? 4
1849+1865-792= 2922
DOUBLE TRIAL Switch point Examestane(3 years) LTZ/ANA (2 years) Randomize Primarysurgery LTZ/ANA(2 years) LTZ/ANA(3 years) Switching period Sequencing period
……….back from S. Antonio 2008: Take home #4 “sequencing TAM with an Ai is better than TAM alone,but it does not offer major advantages vs Ai alone; switching from an Ai to TAM is possible if required… “