The introduction of aromatase inhibitors (AI) has resulted in practice change approaches in the treatment of early breast cancer. In this paper, we analyze the most relevant studies including the ATAC, BIG 1-98, TEAM, MA-17, NSABP B-33, and ABSCG-6 studies. Postmenopausal patients with hormone receptor-positive early breast cancer should be treated with AI for 5 years. For patients who have been initiated with tamoxifen (TAM), switching to an AI to complete 5 years of treatment is also recommended. The results of the extended adjuvant therapy studies recommend the use of an AI (anastrozole, letrozole, or exemestane) after the completion of standard TAM treatment. With regards to premenopausal women, TAM is the recommended adjuvant hormonal treatment for pre- and perimenopausal women. There is no indication for the use of AI in these subgroups of patients. Finally, determination of CYP 2D6 polymorphisms could be considered when choosing the best adjuvant hormonal treatment option.
Aromatase Inhibitors/administration & dosage , Breast Neoplasms/drug therapy , Breast Neoplasms/mortality , Adult , Age Factors , Aged , Anastrozole , Androstadienes/administration & dosage , Androstadienes/adverse effects , Aromatase Inhibitors/adverse effects , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Disease-Free Survival , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Early Detection of Cancer , Female , Humans , Mastectomy/methods , Middle Aged , Neoplasm Staging , Nitriles/administration & dosage , Nitriles/adverse effects , Postmenopause/drug effects , Premenopause/drug effects , Prognosis , Randomized Controlled Trials as Topic , Risk Assessment , Survival Analysis , Tamoxifen/administration & dosage , Tamoxifen/adverse effects , Treatment Outcome , Triazoles/administration & dosage , Triazoles/adverse effects
This phase II trial studied the antitumor effect and toxicity of weekly irinotecan (CPT-11, 125 mg/m(2) 60 min iv infusion, weekly for 4 wk plus 2 wk rest) as second-line chemotherapy in patients with advanced colorectal cancer (CRC) resistant or refractory to prior 5-fluorouracil (5-FU) therapy. Sixty-nine patients with adenocarcinoma (57% in the colon and 43% in the rectum) were enrolled. The median number of treatment cycles received per patient was 4 (range, 1-6). Overall response rate was 18% (95% CI, 9-26), with 4 complete responses (6%) and 8 partial responses (12%), and a median duration of response of 8.1 mo (95% CI, 4.2-12.1). Stable disease was observed in 19 patients (28%). The median time to disease progression was 5.2 mo (95% CI, 4.3-6.1), and the median overall survival was 13.3 mo (95% CI, 9.8-16.8 months). The toxicity profile was favorable: grade 3/4 delayed diarrhea was observed in 10 patients (14.5%) in one cycle each, and grade 3/4 neutropenia in 6 patients (8.7%) and 6 cycles (3.3%). No febrile neutropenia or infection was documented. Grade 3/4 nausea and vomiting were reported in 1 (1.4%) and 7 patients (10.1%), respectively. In conclusion, this phase II trial showed a response rate and a toxicity profile of weekly CPT-11 in line with the results of prior phase II studies.
Adenocarcinoma/drug therapy , Camptothecin/analogs & derivatives , Camptothecin/administration & dosage , Camptothecin/adverse effects , Colorectal Neoplasms/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/secondary , Adult , Aged , Colorectal Neoplasms/mortality , Disease Progression , Drug Administration Schedule , Female , Gastrointestinal Diseases/chemically induced , Hematologic Diseases/chemically induced , Humans , Irinotecan , Male , Middle Aged , Survival Analysis , Treatment Outcome
