Diagnosis and Assessment of Disease
Table 1. Adjuvant Endocrine Therapy: Timing and Sequencing Options
Clinical Setting
If patient is commencing adjuvant endocrine therapy; (patient may have just finished surgery or chemotherapy)
If patient in middle of tamoxifen
If patient in middle of AI
If patient finishing five years of tamoxifen
If patient is pre- or perimenopausal
AI monotherapy Tamoxifen 4 AI
Recommended Duration of Tamoxifen
N/A 2-3 years
Recommended Duration of AI
5 years 2-3 years
Recommended Total Duration of Endocrine Therapy
5 years 5 years
Tamoxifen 4 AI AI 4 Tamoxifen Tamoxifen 4 AI Tamoxifen
2-3 years
2-3 years (administer second)
5 years 5 years
2-3 years
2-3 years (administer first)
3-5 years NR
5 years 5 years 8-10 years 5 years
Selecting a Treatment Regimen AI Interchangeability
ÎMeaningful clinical differences between the commercially available third-generation AIs have not been demonstrated to date.
> There are no data from head-to-head comparisons of the AIs. Two trials - MA.27 and Femara versus Anastrozole Clinical Evaluation (FACE) - are directly comparing one AI against another as primary adjuvant therapy.
> In the absence of direct comparisons, the Update Committee interprets available data as suggesting that benefits of AI therapy represent a "class effect." Meaningful clinical differences between the commercially available third-generation aromatase inhibitors have not been demonstrated to date. In the clinical opinion of the Committee (rather than direct evidence from randomized trials), postmenopausal patients intolerant of one AI but who are still candidates for adjuvant endocrine therapy may be advised to consider tamoxifen or a different AI.
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