Eleftherios (Terry) P. Mamounas, MD, MPH, FACS, medical director of the Comprehensive Breast Program at the University of Florida Health Cancer Center, discusses the role of extended adjuvant endocrine receptor (ER)–positive breast cancer.

According to Mamounas, extended endocrine therapy has demonstrated significant improvement in disease-free survival (DFS) and distant DFS. However, aside from adjuvant tamoxifen, most trials evaluating aromatase inhibitors (AIs) have not shown an improvement in overall survival. 

Additionally, extended duration of adjuvant endocrine therapies is associated with significant toxicity, Mamounas explains.

Tamoxifen and AIs can cause arthralgias and myalgias, Mamounas adds. Moreover, adverse effects, such as decreased bone mineral density, thromboembolic or arterial thrombotic events, osteoporotic fracturs, and fatigue can occur. 

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Eleftherios (Terry) P. Mamounas, MD, MPH, FACS, discusses the role of extended adjuvant endocrine receptor–positive breast cancer.  



Dr. Mamounas on the Role of Extended Adjuvant Endocrine Therapy in ER+ Breast Cancer 

Eleftherios (Terry) P. Mamounas, MD, MPH, FACS, medical director of the Comprehensive Breast Program at the University of Florida Health Cancer Center, discusses common recurrence rates in breast cancer.

When it comes to early stage estrogen receptor (ER)–positive breast cancer, over time, the risk of recurrence is generally stable, says Mamounas. Conversely, with triple-negative breast cancer, the risk of reoccurrence is high in the first 2 to 3 years but, after 5 plus years, it can drop to nearly 0%. 

However, for patients with ER-positive breast cancer, several studies demonstrated that the rate of risk of recurrence and death are typically the highest after the first 5 years, Mamounas adds. 

As shown in larger studies, the rate of distant recurrence is stable from year 5 to 20; however, this depends, to some extent, on the original tumor presentation. Regardless, this is a remarkable rate, Mamounas concludes.



Terry P. Mamounas, MD, MPH, FACS, discusses common recurrence rates in breast cancer.

Dr. Mamounas on Recurrence Rates in Breast Cancer 

Eleftherios (Terry) P. Mamounas, MD, medical director of the Comprehensive Breast Program at the University of Florida Health Cancer Center, discusses the phase III trial for extended letrozole (Femara) therapy for patients with breast cancer.

 The NASBP B-42 trial evaluated the role of letrozole for patients with stage I to IIIA breast cancer that had received 5 years of an aromatase inhibitor (AI) or the combination of tamoxifen (Nolvadex) followed by an AI. Patients who were disease free after 5 years of these treatments were given either letrozole or a placebo for the randomized study.

  The primary endpoints of the study were to prevent breast cancer recurrence and cancer appearing in the opposite breast. The secondary endpoints include breast cancer-free interval, distant recurrence, and an assessment of toxicity in terms of osteoporotic fractures as well as arterial thrombotic events.

Terry P. Mamounas, MD, MPH, FACS

Articles

Dr. Mamounas on the Role of Extended Adjuvant Endocrine Therapy in ER+ Breast Cancer

Dr. Mamounas on Recurrence Rates in Breast Cancer

Dr. Mamounas on Extended Letrozole Therapy for Breast Cancer