Tamoxifen Still a Great Drug
A recent article by Hughes and Wishart in the British Journal of Cancer discusses the continuing value of Tamoxifen in the treatment of estrogen positive breast cancers. Tamoxifen, as you may know, has been around for decades, and the more recent introduction of the AIs has sometimes eclipsed its importance. Tamoxifen has continued to be the standard treatment for women who are still having periods, but post-menopausal women generally receive some combination of Tamoxifen and an AI. All these anti-estrogens are also used in the treatment of Stage IV breast cancer, cancer, usually in a sequential way.
Here is the first paragraph of the study:
The last year has been an interesting time for oncologists interested in the adjuvant hormonal treatment of post-menopausal women with receptor-positive early breast cancer. Three important new pieces of clinical research were presented at the 2008 San Antonio Breast Cancer Symposium: a meta-analysis of the Aromatase Inhibitor (AI) trials (Ingle et al, 2008b) and two individual AI studies (Jakesz et al, 2008; Mouridsen et al, 2008).
These data suggest that it may be premature for oncologists to discard tamoxifen. In this mini review, we analyse whether all patients should be exposed to 2 or 3 years of tamoxifen as part of their adjuvant hormone therapy for receptor-positive early-stage breast cancer treatment (tamoxifen has usually been given first in these trials)
Here is the conclusion:
Recent trial data support the view that AIs should be used after 2 - 3 years of tamoxifen to achieve an OS advantage and add weight to scepticism surrounding up front use of these drugs (Seruga and Tannock, 2009), a strategy which we believe should only be used for women with contraindications to tamoxifen.
If you want to read more:
British Journal of Cancer (2009) 101, 875 - 878. doi:10.1038/sj.bjc.6605231 www.bjcancer.com
Published online 11 August 2009 & 2009 Cancer Research UK