Hormonal Therapy for Breast C... Video Transcript

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And so now our first-line treatment in spread of breast cancer is to use the aromatase inhibitors.

It would make sense, then, that the aromatase inhibitors might be superior to tamoxifen in women who are treated for localized breast cancer.

HOPE RUGO, MD: One of the most exciting pieces of data that was presented was a study looking at the effects of aromatase inhibitor anastrozole in early-stage breast cancer. So prior to this, we've been using these agents in metastatic breast cancer, and they've been working very well.

This study -- called the "ATAC" trial -- actually compared tamoxifen to anastrozole to the combination of tamoxifen and anastrozole for early-stage breast cancer. And very surprising information. There's only about a 2 1/2-year follow-up, so it's very, very early; these are preliminary data.

But it showed that there was less breast cancer recurrence in women taking anastrozole versus either tamoxifen or the combination. So this is very exciting information, and I think in the long term, it's going to change that we give women for early-stage breast cancer.

The one caution that I would say is that, right now we don't know what the side effects are long-term of using an agent that blocks production of estrogen and doesn't have any of the effects we've been talking about with exemestane, potentially.

CATHY CONLEY: Dr. Mortimer, anything you would like to add to that?

JOANNE E. MORTIMER, MD: The downside of this study -- from a quality-of-life standpoint was that there were more bone fractures in women who were taking Arimidex. So we've all been comforted by the benefits of tamoxifen on bone density. So on the other hand, there were fewer hot flashes in women who are taking Arimidex, anastrozole.

CATHY CONLEY: Well, recent data suggests that aromatase inhibitors may be more effective than tamoxifen in breast tumors that express HER2 receptors. Your comments on that?

JOANNE E. MORTIMER, MD: Yes. Now one of the other interesting things that's a distinction between the aromatase inhibitors and tamoxifen, is that cancers that are estrogen-receptor positive and have the HER2 protein, while they may be less sensitive to the aromatase inhibitors, that sensitivity is a little bit more than you see with tamoxifen. That is, if you have both estrogen receptor and HER2 positivity, there is some benefit to the aromatase inhibitors, perhaps more benefit than you see with tamoxifen in that same group.

CATHY CONLEY: Well, Dr. Mortimer, Dr. Rugo, thanks so much for your time and expertise.

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