Tamoxifen Era Ends
Dec. 10, 2001 -- Tamoxifen no longer rules the roost as the leading hormonal treatment for breast cancer.
Reports from this week's San Antonio Breast Cancer Conference show that a newer type of breast-cancer treatment works better than tamoxifen (Nolvadex). The new drugs also appear to avoid tamoxifen's small but important increased risk of uterine cancer.
"Today we have come to the end of the tamoxifen era," Matthew J. Ellis, MD, PhD, tells WebMD. "Now we clearly have tamoxifen replacements that are more effective."
Ellis is clinical director of the breast cancer program at Duke University. He says hormonal therapies have been used to shrink tumors before surgery, to prevent cancer recurrence after surgery and traditional chemotherapy, and to fight advanced breast cancer.
Hormonal treatments for breast cancer work by blocking the tumor-promoting effects of the female sex hormone estrogen. A woman's body keeps on making estrogen even after menopause. Tamoxifen keeps this estrogen from revving up breast cancer cells. The newer drugs, known as aromatase inhibitors or AIs, block the key chemical the body uses to turn other hormones into estrogen. Two of them have received FDA approval: Arimidex and Femara.
One of the most important studies reported at the conference was a huge study of hormonal therapy to prevent breast cancer relapse. This "adjuvant therapy" study enrolled more than 9,000 women from 380 cancer centers in 21 countries. These postmenopausal women -- all of whom had completed first-time surgery and chemotherapy for early breast cancer -- received Arimidex, tamoxifen, or a combination of the two.
After about 31 months of treatment -- with more than 33 months of follow-up -- 10% of the women in the Arimidex group had breast cancer relapse or died. This happened to 12% of the women who got tamoxifen alone or in combination with Arimidex. For women whose tumors were hormone sensitive, Arimidex reduced the risk of relapse by 22%.
"Tamoxifen has been the standard adjuvant therapy for several decades," Lawrence Wickerham, MD, tells WebMD. "Over two-and-a-half years of follow-up, Arimidex shows an advantage."
Wickerham, associate chairman of The National Surgical Adjuvant Breast and Bowel Project (NSABP), was not involved in the study.