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Background: The aromatase inhibitor letrozole is a more effective treatment for metastatic breast cancer and more effective in the neoadjuvant setting than tamoxifen. We compared letrozole with tamoxifen as adjuvant treatment for steroid-hormone-receptor-positive breast cancer in postmenopausal women. Methods: The Breast International Group (BIG) 1-98 study is a randomized, phase 3, doubleblind trial that compared five years of treatment with various adjuvant endocrine therapy regimens in postmenopausal women with hormone-receptor-positive breast cancer: letrozole, letrozole followed by tamoxifen, tamoxifen, and tamoxifen followed by letrozole. This analysis compares the two groups assigned to receive letrozole initially with the two groups assigned to receive tamoxifen initially; events and follow-up in the sequential-treatment groups were included up to the time that treatmentswere switched. Results: A total of 8010 women with data that could be assessed were enrolled, 4003 in the letrozole group and 4007 in the tamoxifen group. After a median follow-up of 25.8 months, 351 events had occurred in the letrozole group and 428 events in the tamoxifen group, with fi ve-year disease-free survival estimates of 84.0 percent and 81.4 percent, respectively. As compared with tamoxifen, letrozole significantly reduced the risk of an event ending a period of disease-free survival (hazard ratio, 0.81; 95 percent confidence interval, 0.70 to 0.93; P = 0.003), especially the risk of distant recurrence (hazard ratio, 0.73; 95 percent confidence interval, 0.60 to 0.88; P = 0.001). Thromboembolism, endometrial cancer, and vaginal bleeding were more common in the tamoxifen group. Women given letrozole had a higher incidence of skeletal and cardiac events and of hypercholesterolemia. Conclusions: In Newsletter1_2006.indd XI 17.02.2006 13:47:37 XII S c h w e iz Newsletter 1/2006 der Schweizerischen Gesellschaft für Senologie postmenopausal women with endocrine-responsive breast cancer, adjuvant treatment with letrozole, as compared with tamoxifen, reduced the risk of recurrent disease, especially at distant sites. (ClinicalTrials.gov number, NCT00004205.) Breast Cancer Research and Treatment High Ep-CAM Expression is Associated with Poor Prognosis in Node-positive Breast Cancer Gilbert Spizzo, Philip Went, Stephan Dirnhofer, Peter Obrist, Ronald Simon, Hanspeter Spichtin, Robert Maurer, Urs Metzger, Brida von Castelberg, Rahel Bart, Shanna Stopatschinskaya, Ossi Robert Köchli, Philip Haas, Friedrich Mross, Markus Zuber, Holger Dietrich, Susanne Bischoff, Martina Mirlacher, Guido Sauter, Guenther Gastl Eur J Cancer 2005; 41: 1446—1452 Impact factor (2004) 3.13 Division of Haematology and Oncology; Department of Pathology, University of Innsbruck, Innsbruck, Austria; Department of Pathology; Department of Internal Medicine; Department of Obstetrics and Gynaecology, University of Basel; Institute of Pathology and Cytology Boss and Spichtin, Basel; Department of Pathology; Department of Surgery, Department of Obstetrics and Gynaecology, City Hospital Zürich, Zürich; Surgery Hospital Olten, Olten, Switzerland; City Hospital Lörrach, Lörrach; Gynaecological Hospital Rheinfelden, Rheinfelden, Germany