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Breast Cancer Treatment: Weighing the Hormonal Options

Tamoxifen has been the standard in hormonal breast cancer treatment for decades. But newer treatments are challenging tamoxifen's superiority.

WebMD Feature

To Kathryn Anderson, the hormonal treatment tamoxifen offered a new lease on life. A survivor of breast cancer, she had been through two surgeries, radiation therapy, and chemotherapy when her doctors put her on tamoxifen.

Anderson is not alone. In the 25-plus years since tamoxifen became a mainstay of breast cancer therapy, the pill has saved thousands of lives. But now, newer hormonal agents known as aromatase inhibitors are contesting the superiority of tamoxifen and competing for attention.

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One of the biggest concerns with tamoxifen is that it stops working after five years, doctors say. Yet one-third of cancers that recur come back between five and 10 years later.

Anderson says that after her five years of tamoxifen therapy ended she always feared a recurrence, feeling that her safety net had gone away.

Until now. A study published in 2004 in The New England Journal of Medicine showed that taking the aromatase inhibitor Aromasin after two to three years of tamoxifen reduced breast cancer recurrence by 32%.

And in 2003, another study in the same journal showed that women could cut their risk of recurrence by nearly half by taking the aromatase inhibitor Femara after they completed about five years on tamoxifen.

And another recent study showed that postmenopausal women who switch to another aromatase inhibitor, Arimidex, after two or three years of tamoxifen therapy had fewer recurrences of cancer than those who continued to take tamoxifen for the full recommended five years.

Aromasin Helps Prevent Cancer Recurrence

The Aromasin study, performed by R. Charles Coombes, MD, PhD, showed that when postmenopausal women took Aromasin for two to three years following two to three years of treatment with tamoxifen, the risk of breast cancer recurrence dropped by 32% compared with women who continued to take tamoxifen.

It's a revolutionary finding, says Paul E. Goss, MD, PhD, director of breast cancer prevention at Toronto's Princess Margaret Hospital and professor of medicine at the University of Toronto. Goss was lead researcher on the Femara study that showed it cut breast cancer recurrence nearly in half after five years of tamoxifen.

"The extent of risk reduction surprised us," Coombes tells WebMD. "It indicates a fair number of people become resistant to tamoxifen two to three years after they start taking it."

Several smaller trials showed that Aromasin may also be effective for the treatment of hormone-responsive metastatic breast cancer. In one study, 122 women who had received no prior hormone therapy were randomly assigned to get tamoxifen or Aromasin. Disease stabilized for at least six months in 57% of those on Aromasin vs. 42% on tamoxifen.

And in a study of 105 women who had previously been on aromatase inhibitors, about one-fourth appeared to benefit from the newer drug.

Aromasin appears to be useful for in women whose breast cancers failed to respond to aromatase inhibitors like Arimidex or Femara, says co-investigator David Cameron, MD, a medical oncologist at Western General Hospital in Edinburgh, Scotland.

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