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Long-Term Efficacy of Anastrozole in Comparison to Tamoxifen for Breast Cancer Patients at ATAC Symposium

This study presents 100-month follow-up data from the ATAC trial comparing Anastrozole and Tamoxifen for postmenopausal women, highlighting continued benefits with Anastrozole and no excess toxicity. Insights on AI use post 5 years are discussed.

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Long-Term Efficacy of Anastrozole in Comparison to Tamoxifen for Breast Cancer Patients at ATAC Symposium

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  1. San Antonio Breast Cancer Symposia Authors: Dr. Sunil Verma Date posted: January 6th, 2008

  2. ATAC: 100 month median follow-up shows continued superior efficacy and no excess fracture risk for anastrozole compared with tamoxifen after treatment completion. Forbes JF, Cuzick J et. al

  3. Background • The ATAC trial is a randomized double-blind trial • At 68 month follow-up, Anastrozole was shown to be superior to Tamoxifen with improved Disease Free Survival. • This presentation provides us with a 100 month update of the ATAC trial. • This is an important update as this is longest follow up of the aromatase inhibitor trials and provides us with long term efficacy and toxicity data.

  4. Treatment A:Anastrozole R Treatment B: Tamoxifen N=6,241 Post menopausal Women

  5. Endpoint • Primary endpoint: • Disease-free survival • Secondary endpoints: • Time to recurrence • Time to distant recurrence • Contralateral breast cancer • Death: all causes • Death after recurrence • Death without recurrence

  6. Patient Characteristics • The average age of patients now with 100 month follow up is 72 years. • There have been in total 1,704 events that have taken place with 1,253 deaths

  7. RESULTS

  8. STUDY COMMENTARY • This is an important study result as now we have 100 month follow up data for an AI in the adjuvant setting. • Tamoxifen is known to have a carry over effect and as such these results show that there is continued benefit with anastrozole despite tamoxifen carry over benefit • There is no difference in overall survival between the two treatment arms • Also given that the average age of patients in this study is now 72 years, there are a number of competing causes of mortality • There are no additional long term toxicities with anastrozole with longer follow-up

  9. BOTTOM LINE FOR CANADIAN MEDICAL ONCOLOGISTS • At 100 month followup, there continues to be a benefit for Anastrozole over Tamoxifen. • There is continued carry over benefit with Anastrozole with longer follow up. • This provides clinician with some comfort when prescribing an AI for 5 years as initially there was some doubt if this benefit would persist after stopping therapy. • We still don’t know if there is an additional benefit of continuing an AI after 5 years. The ongoing MA 17R, NSABP and SALSA trials will help answer this question • Additionally, we still don’t know the best strategy for AI use. The BIG 1.98 trial will be reported in 2008 and will provide us with a comparison of upfront AI and the early switch strategy.

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