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Home: Oncology Leader Commentary: George W. Sledge, MD

Click on the topic below for comments by Dr George W. Sledge to comment on. You will also find links to related articles and clinical trials.

Tyrosine kinase inhitors, antiangiogenic agents
Tyrosine kinase inhitors
Herceptin versus the new tyrosine kinase inhibitors
Combining Herceptin and a tyrosine kinase inhibitors
Combining Herceptin and an Aromotase Inhibitor
Current trends in systemic therapy
Management of metastatic breast cancer
Use of Herceptin in metastatic disease
Assessing HER2 status
Herceptin as a first-line single agent
Endocrine therapy versus cytotoxic therapy of metastatic disease
Tamoxifen rechallenge in patients with prior adjuvant tamoxifen
Chosing an aromatase inhibitor
Aromatase inhibitors as first-line therapy of metastatic disease
Overview of the science of breast cancer medicine.

Choosing an aromatase inhibitor

Interview with Neil Love, MD from Breast Cancer Update for Medical Oncologists, Program 5 2000

Play Audio Below:

Dr. Sledge: I personally don’t see any huge difference yet between the three aromatase inhibitors. We, of course, don’t have any head-to-head trials that tell us that one is superior to the other. So, I think for the average clinician there is no database that would mandate using one over the other. Now, that may change. One of the interesting things that I think we’ve seen has been that at least one of the aromatase inhibitors, exemestane, appears to work in some patients who have failed letrozole, or Arimidex, or aminoglutethimide. We don’t have any data, interestingly enough, about going in the opposite direction, though I’m sure we’ll have that data probably in the next year or two. Why you should progress on one aromatase inhibitor and respond to another is a biologic question that I think is very interesting and one for which I certainly haven’t heard a good explanation, as of yet.

Dr. Love: What are you, yourself using in your practice?

Dr. Sledge: Well I ‘d say, I probably have used Arimidex the most. Having learned a dose of 1mg, once daily, it’s hard to come up with anything simpler than that.

Relevant Links:

Combined endocrine treatment of elderly postmenopausal patients with metastatic breast cancer - A randomized trial of tamoxifen vs. tamoxifen plus aminoglutethimide and hydrocortisone and tamoxifen plu fluoxymesterone in women above 65 years of age.
Rose, C.; Kamby, C.; Mouridsen, H. T.; Andersson, M.; Bastholt, L.; Moller, K. A.; Andersen, J.; Munkholm, P.; Dombernowsky, P., and Christensen, I. J. (Reprint available from: Rose C Odense Univ Hosp, Dept Oncol DK-5000 Odense C Denmark). Breast Cancer Research & Treatment. 61(2):103-110, 2000 May.

Activity of exemestane in metastatic breast cancer after failure of nonsteroidal aromatase inhibitors: A phase II trial.
Lonning, P. E.; Bajetta, E.; Murray, R.; Tubiana-Hulin, M.; Eisenberg, P. D. Mickiewicz, E.; Celio, L.; Pitt, P.; Mita, M.; Aaronson, N. K.; Fowst, C.; Arkhipov, A.; di Salle, E.; Polli, A., and Massimini, G. Journal of Clinical Oncology. 18(11):2234-2244, 2000 Jun.

Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: Results of a phase III randomized double-blind trial.
Kaufmann, M.; Bajetta, E.; Dirix, L. Y.; Fein, L. E.; Jones, S. E.; Zilembo, N.; Dugardyn, J. C.; Nasurdi, C.; Mennel, R. G.; Cervek, J.; Fowst, C.; Polli, A.; di Salle, E.; Arkhipov, A.; Piscitelli, G.; Miller, L. L., and Massimini, G. Journal of Clinical Oncology. 18(7):1399-1411, 2000 Apr.

Cellular responses of mammary carcinomas to aromatase inhibitors: Effects of vorozole. Breast.
Christov, K.; Shilkaitis, A.; Green, A.; Mehta, R. G.; Grubbs, C.; Kelloff, G., and Lubet, R. (Reprint available from: Christov K Univ Illinois, Dept Surg Oncol 840 S Wood St,M-C 820 Chicago, IL 60612 USA). Cancer Research & Treatment. 60(2):117-128, 2000 Mar.

Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: Results of the tamoxifen or arimidex randomized group efficacy and tolerability study.
Bonneterre, J.; Thurlimann, B.; Robertson, J. F. R.; Krzakowski, M.; Mauriac, L.; Koralewski, P.; Vergote, I.; Webster, A.; Steinberg, M., and von Euler, M. Journal of Clinical Oncology. 18(22):3748-3757, 2000 Nov 15.

Formestane is feasible and effective in elderly breast cancer patients with comorbidity and disability.
Venturino, A.; Comandini, D.; Granetto, C.; Audisio, R. A.; Castiglione, F.; Rosso, R., and Repetto, L. (Reprint available from: Venturino A PO S Lazzaro, Via P Belli 26 I-12051 Alba CN Italy). Breast Cancer Research & Treatment. 62(3):217-222, 2000 Aug. In process

Critique of survival update analysis from two phase III anastrozole clinical trials.
Buzdar, A. U.; Wood; Wolter; Vogel; Bland, and Ravdin. Annals of Surgical Oncology. 6(8 Suppl S):8S-11S, 1999 Dec. No abstract

Letrozole: Which dose to be used?
Buzdar, A. U. Journal of Clinical Oncology. 18(8):1802-1803, 2000 Apr. No abstract

Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: Results of a North American multicenter randomized trial.
Nabholtz, J. M.; Buzdar, A.; Pollak, M.; Harwin, W.; Burton, G.; Mangalik, A.; Steinberg, M.; Webster, A., and von Euler, M. Journal of Clinical Oncology. 18(22):3758-3767, 2000 Nov 15.

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