Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 4 2000
Play
Audio Below:
Dr.
Robertson: There are some reasons to hypothesize why, for example,
an aromatase inhibitor, one of the 3rd generations, why
they may be better than tamoxifen. I mean, you could imagine that
tamoxifen eventually does end up as we know in cell culture, stimulating
some of the cancers. And we know, too, that there’s a phenomenon
of tamoxifen withdrawal responses. Whereas it’s difficult to
hypothesize that an aromatase inhibitor eventually ends up stimulating
the cancer. So there are some theoretical reasons to try and explain
this new data we’re seeing in first-line therapy which suggests
a 3rd generation aromatase inhibitor will be better than
tamoxifen in hormone sensitive cancers.
Dr.
Love: What about from a clinical point of view? When you put it
all together do you think that they’re equivalent choices as
first-line therapy or do you think that anastrozole is a better
choice, both in terms of anti-tumor efficacy and side effects profile?
Dr.
Robertson: I’d make one other caveat before I answer that question
for you, which is that this is an initial analysis, and that there
will be a later analysis with longer follow-up. The second caveat
I’d make is that this does generate hypotheses that in ER-positive
tumors an aromatase inhibitor is better than tamoxifen. And the
other thing, which may support that and lend weight to the data
that we now have, is the ATAC data. And if we see a benefit for
the aromatase inhibitor in favor of the ER-positive subgroup, then
that again would give us more confidence in this data for first-line
therapy in advanced disease.
So,
with those two caveats, I would say that on the basis of the information
we have at present, it would seem that if you were going to treat
a patient you would start them on anastrozole rather than tamoxifen.
But, I don’t think that that’s data which you can say
could never change, because there’s more information to come
on a second analysis with more follow-up and also from the ATAC
study. But at the moment, I think in ER-positives, anastrozole is
a better drug than tamoxifen.
