As predicted in yesterday's "What to expect from San Antonio" blog, it does look as though the recommendation is going to be longer duration of hormonal treatments. The ATLAS study (comparing 10 years of Tamoxifen vs 5 years) will be presented today, and early results suggested a 12% reduction in recurrence for women who stayed on treatment longer. This will no doubt raise the next obvious question: What about 15 years? Or even: What about 20 years?
I suspect it may also raise questions about the duration of some other treatments, although I shudder to imagine longer adjuvant chemotherapy regimens.
When I first began to work in Oncology, in 1979, the standard of care for delivery of CMF (at that time the standard adjuvant chemotherapy for early breast cancer) had just been reduced to one year rather than two years. Can you imagine two years on that stuff! By the time I was first diagnosed and received CMF in 1993, the standard of care had been reduced again to six months, and I barely made it through that duration.
For almost all women, the hormonal treatments are very much easier to take than chemotherapy. But it is rather daunting to imagine being on them indefinitely, perhaps forever. Personally, given my own breast cancer history, with the exception of the year (2005) that I was again on chemotherapy, I have been on one or another kind of hormonal therapy since 1994. It is a long time, and I am sure that various parts of my body have aged or ached or wrinkled more quickly than they would have otherwise, but here I am Hard to argue with apparent success.
Here is a summary from MedPage and a link to read more:
Longer Tx to Be Focus for Breast Cancer Docs
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: December 04, 2012
SAN ANTONIO -- Is treatment that lasts twice as long any better than some of the standard therapies in breast cancer? That's the question underlying two major trials that will headline the San Antonio Breast Cancer Symposium this week.
The ATLAS (Adjuvant Tamoxifen Longer Against Shorter) trial comparing 10 years of tamoxifen(Nolvadex) in estrogen receptor-positive early breast cancer to the standard 5-year regimen is slated for presentation Wednesday at the conference.
An earlier look at the trial results after some of the women had completed their second 5 years on the drug indicated a significant 12% reduction in risk of recurrence compared with results when treatment was stopped after the initial 5 years.
If the researchers report better outcomes through the second decade after diagnosis with the 10-year regimen at the conference, practice may change accordingly.