Dr. Farzanna Haffizulla interviews Dr. Lee S. Schwartzberg on Benefits Gained With 5-Year Extended Adjuvant Letrozole Come With a Price.
Thank you for joining us for this practice update i’m dr frazana hafizullah joining me today is dr lee schwartzberg senior partner and medical director at the west clinic 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 astral
Plenary session the randomized trial ma17r 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 some more on this particular trial in the planetary session
Sure we’ve been expecting this trial for some time now we know that extended adjuvant endocrine therapy with ten years of tamoxifen is better than five years of tamoximen based on two clinical trials that have been published in the last couple of years adam and atlas what we’ve been waiting for though is what the benefit is of 10 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 ma17 the original trial proved that five more years of an aromatase inhibitor letrozole was superior to just the five years of tamoxifen so we have this tenure 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 um ma17r which was a re-randomization 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 five years into maximum five years of a neromatase inhibitor and then another five years of romanticism 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 that five years of tamoxifen gives protection up to 15 years later
But what we’ve 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 we haven’t seen the full results of the trial yet as we’re talking today but um 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 uh adjuvant aromatase inhibitors in the contemporary uh setting absolutely now how do these results add to last year’s plenary session where the results of the soft trial the 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 who 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 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 chemotherapy 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 agonist which
Suppressed 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 ma17r is what happens to those women who now got if you will the best adjuvant 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 answers but as always we’ll use extrapolation until we have clinical trials so i think they’re 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 have set up for 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 ovarian
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’ve been weighing the risks and benefits
Transcribed from video
Benefits Gained With 5-Year Extended Adjuvant Letrozole Come With a Price By PracticeUpdate
