Thank you for joining us for this practice update i’m dr. prasanna half azula joining me today is dr. lee schwartzberg senior partner and medical director at the west linic in memphis tennessee dr. schwartzberg it’s wonderful to have you here today thank you i’m very pleased to be here excellent well i wanted to discuss some of the results of the following oscar
Plenary session the randomized trial ma 17 are that looked at extending adjuvant letrozole for five years after completing an initial five years of aromatase inhibitor therapy alone or preceded by tamoxifen in postmenopausal women with early-stage breast cancer can you elucidate a little bit more elaborate more on this particular trial in the plenary session sure
We’ve been expecting this trial for some time now we know that extended edge of an endocrine therapy with 10 years of tamoxifen is better than five years of tamoxifen based on to clinical trials that have been published in the last couple years adam and atlas what we’ve been waiting for though is what the benefit is of ten years of an aromatase inhibitor because
Most postmenopausal women today are started on an aromatase inhibitor and get that for five years many premenopausal women still get tamoxifen as the standard of care for five years and ma 17 the original trial approved that five more years of an aromatase inhibitor letrozole was in superior to just the five years of tamoxifen so we have this ten-year data in a
Few subsets the subset we don’t have is the one that we want the most what happens after five years of an aromatase inhibitor is an extra five years better than not so that’s what ma 17 are which was a rear and amaze a shin basically to that group now the trial is also complicated by the fact that there were some patients who were put on after 10 years of endocrine
Therapy the original trial 5 is maximum five years of an aromatase inhibitor and another five years of aroma taste so people might think why are we doing so much adjuvant endocrine therapy this is a really long time to keep people on therapy and we know from the original trials at five years of tamoxifen what gives protection up to 15 years later but what we
Learned over the last few years is that women with er-positive early stage breast cancer are at risk of relapsing up to 15 or even 20 years later so extended adjuvant therapy may play an important role absolutely haven’t seen the full results of the trial yet as we’re talking today but we expect since it is in the plenary session for it to be a positive trial and
Will give us answers as to how long we should treat patients with adjuvant aromatase inhibitors in the contemporary setting absolutely now how do these results at the last year’s plenary session where results with a soft trial that suppression of ovarian function trial was presented right so we have a different type of data set there the focus there was taking
Younger women who are premenopausal yes traditionally get tamoxifen and seeing if you added ovarian function suppressions or suppressing their ovaries and then allowing them to have an aromatase inhibitor because the aromatase inhibitors do not work in premenopausal people they only work in the absence of ovarian function so by suppressing that and then adding an
Aromatase inhibitor we learned that in high-risk patients very young women under 35 with er-positive breast cancer or women who were deemed to have chemother needed chemotherapy either because they had no positive disease or larger tumors or some other factor they got benefit from taking five years of a lhrh agonists which suppress their ovarian function plus the ai
Compared to tamoxifen so now we’re kind of left in a little bit of a quandary because we know that but what we’re not going to know even after ma 17 are is what happens to those women who now got if you will the best a german endocrine therapy in the premenopausal setting what do you do after five years with those women do you continue ovarian function suppression
Do you go back to tamoxifen there we’re not going to have the full lance’s but as always we’ll use extrapolation until we have clinical trials so i think that complementary but they don’t answer every question absolutely and sometimes you know looking at the patient’s preferences as well thinking about reproductive potential and answering those particular kinds of
Questions will play a role in any kind of treatment plan that you i’ve set up absolutely it’s a great point so the big problem with soft was that these are women who are premenopausal some of them in their prime years for fertility and are interested in having children and they get side effects so a variant function suppression causes menopausal symptoms and they can
Be fairly severe in a subset of patients so we always have to weigh is it really worth doing that additional maneuver for the benefit and there is benefit but that’s why i say most of us are using the soft data in higher risk women if you have a very small hormone receptor-positive tumor tamoxifen alone may be enough and particularly when you bit then if weighing the risks and benefits
Transcribed from video
Benefits Gained With 5-Year Extended Adjuvant Letrozole Come With a Price.mp4 By PracticeUpdate
