Exploring Adjuvant Endocrine Therapy in the Breast Cancer Setting

Terry P. Mamounas, MD, MPH, medical director of the Comprehensive Breast Program at the University of Florida Health Cancer Center, discusses the use of extended adjuvant therapy for patients with breast cancer and how the landscape is evolving.

Mamounas says that physicians in this setting know that extended adjuvant therapy works for patients and the extent that it works when using tamoxifen (Nolvadex) after an aromatase inhibitor, which gives a significant benefit. There is less benefit when giving an aromatase inhibitor after the patient had already received an aromatase inhibitor for 5 years or so. Generally, studies of adjuvant therapy have shown a small absolute benefit and a 4% to 7% decrease in recurrence. For any agent where there is a 4% or 5% absolute reduction in recurrence, 95% of the patients do not need the intervention because they won’t recur without it or they would recur even with it, Mamounas explains.

Physicians need to find a better way to identify patients who need the additional treatment, according to Mamounas. He and his colleagues looked at multiple strategies to do this. One strategy is looking at primary tumor characteristics in patients; if they have a bigger tumor or positive nodes, the patients rate of recurrence is higher than if they had a smaller tumor or negative nodes. Clinical pathologic algorithms have been developed including 1 called CTS5, which looks at clinical tumor characteristics and predictions after 5 years. It looks at tumor size, nodal status, disease grade, and age of the patient. By putting all of these factors together in an algorithm, physicians can predict what will happen after 5 years.

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