The 5-Year Disease-Free Survival of Third Generation Aromatase Inhibitor for Postmenopausal Women with HR-positive HER2-negative Non-Metastatic Breast Cancer
,
Abstract
Background: Several studies showed the superiority of aromatase inhibitor (AI) as first-line therapy for patients with hormone-receptor (HR)-positive breast cancer (BC). For the clinician, studies in the real-world are warranted to determine treatment based on the efficacy of each drug. We conducted a comparison of 5-y disease-free survival (DFS) of each AI in terms of survival benefit.
Materials and Methods: We evaluated 450 medical records of postmenopausal women at Dr. Sardjito General Hospital who were diagnosed with HR-positive HER2-negative BC (stage I – III) from January to December 2019 and had undergone surgery, received chemotherapy or radiation therapy, and at least one year of anastrozole, letrozole, or exemestane administration. Kaplan Meier estimation survival curve was used to analyse of survival rate.
Result: Of 79 patients meeting inclusion criteria, there were 21.52% distant metastases documented. Time to disease progression of anastrozole, letrozole and exemestane was 49 months, 58 months, and 53 months, respectively. Letrozole was found better than anastrozole (hazard ratio (HR)=4.342, 95% CI 0.95-19.95; p=0.038). Letrozole versus exemestane (HR=2.757, 95% CI 0.53-14.33; p=0,206) and anastrozole versus exemestane (HR=1.652, 95% CI 0.56-4.84; p=0.351) were found not significantly different. 5-y DFS rate of letrozole was better found (87.5%) than exemestane (73.7%) and anastrozole (61,4%).
Conclusion: 5-year letrozole administration could be proposed as first-line therapy for postmenopausal women with HR-positive HER2-negative BC. A considerable subject and long-term follow-up are needed for validation.
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18. Robarge JD, Desta Z, Nguyen AT, et al. Effects of exemestane and letrozole therapy on plasma concentrations of estrogens in a randomized trial of postmenopausal women with breast cancer. Breast Cancer Res Treat. 2017; 161(3): 453–461.
19. Ellis MJ, Suman VJ, Hoog J, et al. Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype--ACOSOG Z1031. J Clin Oncol. 2011; 29(17): 2342–9.
20. Miller WR, Bartlett J, Brodie AMH, et al. Aromatase inhibitors: are there differences between steroidal and nonsteroidal aromatase inhibitors and do they matter?. Oncologist. 2008; 13(8) 829–837.
21. Zangouri VM, Akrami MM, Tahmasebi SM, et al. Medullary Breast Carcinoma and Invasive Ductal Carcinoma: A Review Study. Iran J Med Sci. 2018; 43(4): 365–371.
22. Wangsa I, Wayan N, Adiputra P, et al. Gambaran stadium dan jenis histopatologi kanker payudara di Subbagian Bedah Onkologi RSUP Sanglah Denpasar tahun 2015-2016. Intisari Sains Medis. 2018; 9(1):80-84.
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24. Hasegawa Y, Tanino H, Horiguchi J, et al. Randomized Controlled Trial of Zoledronic Acid plus Chemotherapy versus Chemotherapy Alone as Neoadjuvant Treatment of HER2-Negative Primary Breast Cancer (JONIE Study). PloS One. 2015; 10(12): e0143643.
25. Sakr H, Hamed RH, Anter AH, et al. Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University). Med Oncol.2013;30(1): 457.
26. Coudert B, Asselain B, Campone M, et al. Extended benefit from sequential administration of docetaxel after standard fluorouracil, epirubicin, and cyclophosphamide regimen for node-positive breast cancer: the 8-year follow-up results of the UNICANCER-PACS01 trial. Oncologist. 17(7): 900–909.
27. Sagara Y, Kosha SH, Baba SH, et al. Adverse events and bone health during anastrozole therapy in postmenopausal Japanese breast cancer patients. Breast Cancer. 2010; 17(3): 212–217.
28. Im SA, Mukai H, Park IH, et al. Palbociclib Plus Letrozole as First-Line Therapy in Postmenopausal Asian Women With Metastatic Breast Cancer: Results From the Phase III, Randomized PALOMA-2 Study. J Glob Oncol. 2019; 5:1-19.
29. Sonke GS, Hart LL, Campone M, et al. Ribociclib with letrozole vs letrozole alone in elderly patients with hormone receptor-positive, HER2-negative breast cancer in the randomized MONALEESA-2 trial. Breast Cancer Res Treat. 2018; 167(3): 659–669.
30. Goss PE, Ingle JN, Pritchard KI, et al. Exemestane versus anastrozole in postmenopausal women with early breast cancer: NCIC CTG MA.27--a randomized controlled phase III trial. J Clin Oncol.2013; 31(11): 1398–1404.
31. Yazdani A, Yaseri M, Haghighat SH, et al. Investigation of Prognostic Factors of Survival in Breast Cancer Using a Frailty Model: A Multicenter Study. Breast Cancer (Auckl). 2019;13:1178223419879112.
32. Corbeau I, Jacot W, Guiu S. Neutrophil to Lymphocyte Ratio as Prognostic and Predictive Factor in Breast Cancer Patients: A Systematic Review. Cancers (Basel). 2020;12(4):958.
2. Lin PL, Hao Y, Xie J, et al. Real-world effectiveness of everolimus-based therapy versus endocrine monotherapy and chemotherapy in patients of HR+/HER2- breast cancer with liver metastasis in the USA. Expert Opin. Pharmacother.2015; 16(14): 2101–2111.
3. Anderson WF, Rosenberg RS, Prat A, et al. How many etiological subtypes of breast cancer: two, three, four, or more?.J Natl Cancer Inst. 2014; 106(8): dju165.
4. Panigoro S, Hernowo BS, Purwanto H, et al. Panduan Penatalaksanaan Kanker Payudara. Kementerian Kesehatan Republik Indonesia. Komite Penanggulangan Kanker Nasional, 2015.
5. Moo TA, Sanford R, Dang CH, et al. Overview of Breast Cancer Therapy. PET Clin.2018; 13(3): 339–354.
6. Abdulkareem IH, Zurmi IB. Review of hormonal treatment of breast cancer. Niger J Clin Pract. 2012; 15(1): 9–14.
7. Coates AS, Keshaviah A, Thürlimann B, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol Off J Am Soc Clin Oncol. 2007; 25(5): 486–492.
8. Forbes JF, Cuzick J, Buzdar A, et al.“Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008; 9(1): 45–53.
9. Zhang J, Huang Y, Wang C, et al. Efficacy and safety of endocrine monotherapy as first-line treatment for hormone-sensitive advanced breast cancer. Medicine (Baltimore); 96(33): e7846.
10. Diéras V, Harbeck N, Joy AA, et al. Palbociclib with Letrozole in Postmenopausal Women with ER+/HER2- Advanced Breast Cancer: Hematologic Safety Analysis of the Randomized PALOMA-2 Trial. Oncologist. 2019; 24(12): 1514–1525.
11. Smith I, Yardley D, Burris H, et al. Comparative Efficacy and Safety of Adjuvant Letrozole Versus Anastrozole in Postmenopausal Patients With Hormone Receptor-Positive, Node-Positive Early Breast Cancer: Final Results of the Randomized Phase III Femara Versus Anastrozole Clinical Evaluation (FACE) Trial. J Clin Oncol. 2017; 35(10): 1041–1048.
12. Pritchard KI, Burris 3rd HA, Ito Y, et al. Safety and efficacy of everolimus with exemestane vs. exemestane alone in elderly patients with HER2-negative, hormone receptor-positive breast cancer in BOLERO-2. Clin Breast Cancer. 2013;13(6):421-432.e8.
13. Wahyuni FS, Windrasari W, Khambri DD, et al .Evaluasi Terapi Adjuvant Hormonal Dan Hubungannya Terhadap Outcome Klinis Pasien Kanker Payudara Stadium Dini Di Kota Padang. J Sains Farm Klin. 2019; 5(3): 176–184.
14. Pulido C, Vendrell I, Ferreira AR, et al. Bone metastasis risk factors in breast cancer. Ecancermedicalscience. 2017; 11:715.
15. Bighin C, Dozin B, Poggio F, et al. Hormonal therapy followed by chemotherapy or the reverse sequence as first-line treatment of hormone-responsive, human epidermal growth factor receptor-2 negative metastatic breast cancer patients: results of an observational study. Oncotarget. 2017: 8(27): 44800–44810.
16. Beck JT, Hortobagyi GN, Campone M, et al. Everolimus plus exemestane as first-line therapy in HR+, HER2− advanced breast cancer in BOLERO-2. Breast Cancer Res. Treat. 2014; 143(3): 459–67.
17. Goss PE, Ingle JN, Pritchard KI, et al. Exemestane versus anastrozole in postmenopausal women with early breast cancer: NCIC CTG MA.27--a randomized controlled phase III trial. J Clin Oncol. 2013; 31(11): 1398–404.
18. Robarge JD, Desta Z, Nguyen AT, et al. Effects of exemestane and letrozole therapy on plasma concentrations of estrogens in a randomized trial of postmenopausal women with breast cancer. Breast Cancer Res Treat. 2017; 161(3): 453–461.
19. Ellis MJ, Suman VJ, Hoog J, et al. Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype--ACOSOG Z1031. J Clin Oncol. 2011; 29(17): 2342–9.
20. Miller WR, Bartlett J, Brodie AMH, et al. Aromatase inhibitors: are there differences between steroidal and nonsteroidal aromatase inhibitors and do they matter?. Oncologist. 2008; 13(8) 829–837.
21. Zangouri VM, Akrami MM, Tahmasebi SM, et al. Medullary Breast Carcinoma and Invasive Ductal Carcinoma: A Review Study. Iran J Med Sci. 2018; 43(4): 365–371.
22. Wangsa I, Wayan N, Adiputra P, et al. Gambaran stadium dan jenis histopatologi kanker payudara di Subbagian Bedah Onkologi RSUP Sanglah Denpasar tahun 2015-2016. Intisari Sains Medis. 2018; 9(1):80-84.
23. Irwan I, Azamris A, Bachtiar H. Perbandingan Prognosis Subtipe Molekuler Kanker Payudara Antara Pasien Kanker Payudara Wanita Usia Muda dan Tua di RSUP DR. M. DJAMIL PADANG. Maj Kedokt Andalas. 2016; 38(3): 208–217.
24. Hasegawa Y, Tanino H, Horiguchi J, et al. Randomized Controlled Trial of Zoledronic Acid plus Chemotherapy versus Chemotherapy Alone as Neoadjuvant Treatment of HER2-Negative Primary Breast Cancer (JONIE Study). PloS One. 2015; 10(12): e0143643.
25. Sakr H, Hamed RH, Anter AH, et al. Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University). Med Oncol.2013;30(1): 457.
26. Coudert B, Asselain B, Campone M, et al. Extended benefit from sequential administration of docetaxel after standard fluorouracil, epirubicin, and cyclophosphamide regimen for node-positive breast cancer: the 8-year follow-up results of the UNICANCER-PACS01 trial. Oncologist. 17(7): 900–909.
27. Sagara Y, Kosha SH, Baba SH, et al. Adverse events and bone health during anastrozole therapy in postmenopausal Japanese breast cancer patients. Breast Cancer. 2010; 17(3): 212–217.
28. Im SA, Mukai H, Park IH, et al. Palbociclib Plus Letrozole as First-Line Therapy in Postmenopausal Asian Women With Metastatic Breast Cancer: Results From the Phase III, Randomized PALOMA-2 Study. J Glob Oncol. 2019; 5:1-19.
29. Sonke GS, Hart LL, Campone M, et al. Ribociclib with letrozole vs letrozole alone in elderly patients with hormone receptor-positive, HER2-negative breast cancer in the randomized MONALEESA-2 trial. Breast Cancer Res Treat. 2018; 167(3): 659–669.
30. Goss PE, Ingle JN, Pritchard KI, et al. Exemestane versus anastrozole in postmenopausal women with early breast cancer: NCIC CTG MA.27--a randomized controlled phase III trial. J Clin Oncol.2013; 31(11): 1398–1404.
31. Yazdani A, Yaseri M, Haghighat SH, et al. Investigation of Prognostic Factors of Survival in Breast Cancer Using a Frailty Model: A Multicenter Study. Breast Cancer (Auckl). 2019;13:1178223419879112.
32. Corbeau I, Jacot W, Guiu S. Neutrophil to Lymphocyte Ratio as Prognostic and Predictive Factor in Breast Cancer Patients: A Systematic Review. Cancers (Basel). 2020;12(4):958.
| Files | ||
| Issue | Vol 17, No 1 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v17i1.11713 | |
| Keywords | ||
| Aromatase inhibitor; Breast cancer; Disease-free survival; HR-positive; Postmenopause | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Etikasari R, Andayani T, Endarti D, Taroeno-Hariadi K. The 5-Year Disease-Free Survival of Third Generation Aromatase Inhibitor for Postmenopausal Women with HR-positive HER2-negative Non-Metastatic Breast Cancer. Int J Hematol Oncol Stem Cell Res. 2023;17(1):48-55.
