New insights on hormonal therapies

The theme of this morning's SABCS session was adjuvant hormonal therapy--an important topic given the fact that 70 percent of all women with early stage breast cancer receive this. Aromatase inhibitors (AIs) have become the preferred type of hormonal therapy over tamoxifen for postmenopausal women as this leads to fewer recurrences. The TEAM trial looked at the "switching" strategy of tamoxifen for two to three years followed by the AI Aromasin (exemestane) for two to three years compared to Aromasin for five years and found this to be equivalent. It was nice to hear very educated questions from a breast cancer advocate at the end of this session inquiring as to whether genetic variations that affect tamoxifen metabolism were examined, and the response was that this relevant issue will be examined in the near future. The older IES study that compared the switching regimen to tamoxifen for five years continues to show lowered recurrence, now with a slight survival. Therefore, we have solid evidence to show that an AI, whether used for the full five years, or for three years after two years of tamoxifen is better than tamoxifen alone. The big question now is whether more than five years of an AI (or more than three years if you took tamoxifen for two years prior to the AI) will be even better, and this is currently being studied. Another study called MA.17 had already shown that five years of the AI Femara (letrozole) given after five years of tamoxifen is better than just five years of tamoxifen. Today, a sub-analysis was presented on the few patients who were premenopausal at the time of diagnosis and either had their ovaries removed or went through menopause during chemotherapy, but before hormonal therapy started. This showed a more pronounced effect of letrozole, so it will be interesting to see if this can be confirmed in other trials. Finally, in this and other studies, analysis of inherited genes showed that a specific variation in a gene, involved in inflammation and immunity, might be responsible for some of the side effects seen with AIs. Understanding this mechanism might lead to understanding who might be at risk for these side effects and might even lead to treatment for the few patients in which these side effects are disabling.Alcohol has been shown to be a mild risk factor for breast cancer in numerous studies, but we do not know if women already diagnosed with breast cancer might have a higher risk of recurrence based on alcohol use. The research group at Kaiser reported a large series of nearly 2,000 patients with breast cancer who were given extensive questionnaires on diet, alcohol, and other lifestyle factors. With about eight years of follow-up, patients who consumed three to four drinks a week or more had approximately one-third more recurrences and about one-half more breast cancer deaths. However, alcohol might protect against heart disease, which might explain the fact that deaths from other causes were lower, although this was not statistically significant. This adds more reason to suggest a comprehensive lifestyle approach to moderate or minimize alcohol use as well as to follow a heart-healthy diet and a physical activity regimen for everyone.To read more articles from CURE's coverage of SABCS 2009, visit sabcs2009.curetoday.com