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Ten years of tamoxifen help reduce breast cancer recurrence and death

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C. Zielinski shares his comments on findings from the aTTom study presented at ASCO 2013 Annual Meeting. In ER-positive disease, continuing tamoxifen to 10 years produces further reductions in recurrence and breast cancer mortality in premenopausal women. He elaborates on evidence supportive for change in the practice and discusses on use of first targeted agent at the global scale.

We’re here at the oscar nom meeting 2013 with professor solinsky from vienna austria and we would like to ask a few questions on our study that was presented in a plenary session about the results obtained continuing the use of tamoxifen for ten years instead of five years in breast cancer patients so can you briefly summarize the results this important study

Called atom study comes from great britain and it had recruited around 7,000 patients and complemented a previous report of the atlas study which included 11,000 patients and was shown at the san antonio breast cancer conference now together when you were adding the patients up this amounted to about 17,000 patients and the concept was to test five versus 10 years

Of tamoxifen now the study has been recruiting for a long time and was presented here at asco i think five years ago and at that time had the negative result the interesting aspect is that obviously the progression-free survival really splits after seven years and then you really see the difference in progression-free survival explaining the previously negative

Results and now the positive results the positive results are not only significant but they extend on previous observations which were there by the other breast cancer trial it’s co-operative group that tamoxafin leads to even a reduction in progression-free survival after stopping it after five years and you saw late results of the the period which was simply

Observing patients and them without taking any tamoxifen so the idea was to extend it to a further ten years and to see where the similar effect could be achieved the fact is that progression-free survival was highly significant in the patient population receiving tamoxifen for ten years as compared to five years and that overall survival when data were lumped

Together between the atom and the etlis study showed a reduction in the second decade of overall survival by 50% as compared to patients who did not take tamoxifen at all so this is a very major step forward and recommends the intake of tamoxifen for 10 years in 3 min apostle women we should not forget that the moxa phone was one of the first drugs which was truly

A targeted drug because it targeted the eastridge n receptor and in the endocrine dependence of two tumors now one of the drawbacks of the study that we witnessed was that at the very beginning patients had an unknown endocrine receptor status which means that tamoxifen not necessarily was effective in this patient group so probably the difference would have been

Even bigger if patients who were all endocrine receptor positive would have been included rather than also such who were of an unknown endocrine receptor status now i think it is mandatory to use the marks if any patients who are pre menopausal and have an endocrine dependent disease we know that this reduces that reduces recurrence we know that this reduces very

Significantly survival and there’s no doubt that patients who are not receiving tamoxifen have a relapse rate of about 50% whereas patients who do use tamoxifen only one-third so we have an enormous advantage of using this ruggle though is that all drug but it proves the concept of targeted treatment to be valid for a very long time i think it’s now almost 40 years

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Ten years of tamoxifen help reduce breast cancer recurrence and death By European Society for Medical Oncology