Application status of tamoxifen in endocrine therapy for early breast cancer

Hu,Qiancheng; Luo,Ting; Zhong,Xiaorong; He,Ping; Tian,Tinglun; Zheng,Hong

doi:10.3892/etm.2015.2437

Application status of tamoxifen in endocrine therapy for early breast cancer

Authors:
- Qiancheng Hu
- Ting Luo
- Xiaorong Zhong
- Ping He
- Tinglun Tian
- Hong Zheng
View Affiliations

Affiliations: Departments of Head and Neck and Mammary Gland Oncology, and Medical Oncology, Cancer Center; State Key Laboratory of Biotherapy, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
Published online on: April 20, 2015 https://doi.org/10.3892/etm.2015.2437
Pages: 2207-2212

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to investigate the application status of tamoxifen as an adjuvant treatment for early‑stage breast cancer. Data for patients with early breast cancer were collected from an information management system for breast cancer in a single hospital between 1989 and 2012. The inclusion criteria included no distant metastasis during diagnosis with breast cancer, and a diagnosis of estrogen and/or progesterone receptor‑positive breast cancer, or an unclear hormonal receptor status with tamoxifen used as the preferred drug. A total of 2,738 patients were selected, with 99.4% female and 0.6% male patients. Within females, 75.7% were premenopausal when diagnosed with early breast cancer, 24.3% were postmenopausal, and the median age of menopause was 47 years. The percentage of tamoxifen preference in adjuvant therapy was 97.3% prior to 2000, which decreased to 60.4% in 2011. Tamoxifen preference among premenopausal patients reduced from 97.3% prior to 2000 to 89.5% in 2011, while in postmenopausal patients tamoxifen preference declined from 97.4% prior to 2000 to 22.7% in 2011. One‑year duration of tamoxifen treatment accounted for 79.4% of cases, while five‑year duration accounted for 24.7%. The rate of one‑year disease‑free survival (DFS) was 98.5% and of five‑year DFS was 89.1%. Patients with early breast cancer had a one‑year overall survival (OS) rate of 99.2% and a five‑year OS rate of 95.6%. The gradually decreased usage and shortened duration of tamixofen treatment, as well as reduced DFS and OS rates were observed in a ‘real world’ clinical setting. Improved treatment compliance in patients is recommended.

View Figures

View References

1	Althuis MD, Dozier JM, Anderson WF, Devesa SS and Brinton LA: Global trends in breast cancer incidence and mortality 1973–1997. Int J Epidemiol. 34:405–412. 2005. View Article : Google Scholar : PubMed/NCBI
2	Parkin DM, Bray FI and Devesa SS: Cancer burden in the year 2000 The global picture. Eur J Cancer. 37:(Suppl 8). S4–S66. 2001. View Article : Google Scholar : PubMed/NCBI
3	Park WC and Jordan VC: Selective estrogen receptor modulators (SERMS) and their roles in breast cancer prevention. Trends Mol Med. 8:82–88. 2002. View Article : Google Scholar : PubMed/NCBI
4	Cohen MH, Hirschfeld S, Flamm Honig S, et al: Drug approval summaries: arsenic trioxide, tamoxifen citrate, anastrazole, paclitaxel, bexarotene. Oncologist. 6:4–11. 2001. View Article : Google Scholar : PubMed/NCBI
5	Fisher B, Costantino JP, Wickerham DL, et al: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 90:1371–1388. 1998. View Article : Google Scholar : PubMed/NCBI
6	Early Breast Cancer Trialists' Collaborative Group (EBCTCG): Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365:1687–1717. 2005. View Article : Google Scholar : PubMed/NCBI
7	Davies C, Pan H, Godwin J, et al: Longer Against Shorter (ATLAS) Collaborative Group: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 381:805–816. 2013. View Article : Google Scholar : PubMed/NCBI
8	Fisher B, Dignam J, Bryant J and Wolmark N: Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial. J Natl Cancer Inst. 93:684–690. 2001. View Article : Google Scholar : PubMed/NCBI
9	Barron TI, Connolly R, Bennett K, Feely J and Kennedy MJ: Early discontinuation of tamoxifen: a lesson for oncologists. Cancer. 109:832–839. 2007. View Article : Google Scholar : PubMed/NCBI
10	Wigertz A, Ahlgren J, Holmqvist M, et al: Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study. Breast Cancer Res Treat. 133:367–373. 2012. View Article : Google Scholar : PubMed/NCBI
11	Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM and Vernon SW: Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 134:459–478. 2012. View Article : Google Scholar : PubMed/NCBI
12	Thorpe KE, Zwarenstein M, Oxman AD, et al: A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 62:464–475. 2009. View Article : Google Scholar : PubMed/NCBI
13	Booth CM and Mackillop WJ: Translating new medical therapies into societal benefit: the role of population-based outcome studies. JAMA. 300:2177–2179. 2008. View Article : Google Scholar : PubMed/NCBI
14	Krumholz HM: Real-world imperative of outcomes research. JAMA. 306:754–755. 2011. View Article : Google Scholar : PubMed/NCBI
15	Kaptchuk TJ: The double-blind, randomized, placebo-controlled trial: gold standard or golden calf? J Clin Epidemiol. 54:541–549. 2001. View Article : Google Scholar : PubMed/NCBI
16	Hershman DL and Wright JD: Comparative effectiveness research in oncology methodology: observational data. J Clin Oncol. 30:4215–4222. 2012. View Article : Google Scholar : PubMed/NCBI
17	Trotter JP: Patient registries: a new gold standard for ‘real world’ research. Ochsner J. 4:211–214. 2002.PubMed/NCBI
18	Parkin DM: The evolution of the population-based cancer registry. Nat Rev Cancer. 6:603–612. 2006. View Article : Google Scholar : PubMed/NCBI
19	Albain KS, Barlow WE, Ravdin PM, et al: Breast Cancer Intergroup of North America: Adjuvant chemotherapy and timing of tamoxifen in postmenopausal patients with endocrine-responsive, node-positive breast cancer: a phase 3, open-label, randomised controlled trial. Lancet. 374:2055–2063. 2009. View Article : Google Scholar : PubMed/NCBI
20	Hershman DL, Shao T, Kushi LH, et al: Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 126:529–537. 2011. View Article : Google Scholar : PubMed/NCBI
21	Goss PE, Ingle JN, Martino S, et al: A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med. 349:1793–1802. 2003. View Article : Google Scholar : PubMed/NCBI
22	Coombes RC, Hall E, Gibson LJ, et al: Intergroup Exemestane Study: A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med. 350:1081–1092. 2004. View Article : Google Scholar : PubMed/NCBI
23	Howell A, Cuzick J, Baum M, et al: ATAC Trialists' Group: Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 365:60–62. 2005. View Article : Google Scholar : PubMed/NCBI
24	Baum M, Budzar A, Cuzick J, et al: ATAC Trialists' Group: Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 359:2131–2139. 2002. View Article : Google Scholar : PubMed/NCBI
25	Goldhirsch A, Wood WC, Gelber RD, et al: Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol. 21:3357–3365. 2003. View Article : Google Scholar : PubMed/NCBI
26	Thürlimann B, Keshaviah A, Coates AS, et al: Breast International Group (BIG) 1–98 Collaborative Group: A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med. 353:2747–2757. 2005. View Article : Google Scholar : PubMed/NCBI
27	Goldhirsch A, Ingle JN, Gelber RD, et al: Panel members: Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol. 20:1319–1329. 2009. View Article : Google Scholar : PubMed/NCBI
28	Forbes JF, Cuzick J, Buzdar A, et al: Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trialists' Group: Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 9:45–53. 2008. View Article : Google Scholar : PubMed/NCBI