A randomised study of the effects of letrozole and anastrozole on oestrogen receptor positive breast cancers in postmenopausal women. Breast Cancer Res Treat

Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 04/2008; 114(3):495-501. DOI: 10.1007/s10549-008-0027-0
Source: PubMed


Changes in proliferation as measured by Ki67 occur within 14 days of starting treatment with an aromatase inhibitor and these changes have been shown to be predictors of long term outcome. This study aimed to compare changes in proliferation following 14 days of treatment with anastrozole and letrozole.
Two hundred and six women with 209 estrogen receptor (ER) positive operable breast cancers (three bilateral) were randomly allocated to receive either 14 days treatment with 2.5 mg of letrozole or 1 mg of anastrozole prior to surgery. Changes in expression of estrogen (ER) and progesterone receptors (PgR) as assessed by ALLRED scores and proliferation as assessed by Ki67 were analysed. The HER2 status of each tumour was also assessed using a combination of the Hercept test and FISH.
Both letrozole and anastrozole reduced ER expression (ALLRED score) by a mean of 0.32 (0.20-0.44), P<0.001 and PgR fell by a mean of 2.54 (2.20-2.89) P<0.0001. Letrozole reduced proliferation from a geometric mean of 6.37% to 0.81%, P<0.0001 and anastrozole reduced proliferation from 5.81% to 0.77%, P<0.0001. There was no differences between drugs in the fall in ER, PgR or proliferation. Both letrozole and anastrozole produced significant falls in proliferation in both HER2 positive and HER2 negative cancers, all P<0.001.
14 days of both letrozole and anastrozole reduces proliferation, ER and PgR expression. No significant difference between these two drugs was identified.

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    • "Increasing evidence suggests that non-steroid AIs40 are highly specific, potent and have less adverse effects during breast cancer treatment. These AIs such as anastrozole and letrozole41,42, by non-covalently binding to the aromatase enzyme heme moiety and preventing androgen binding by saturating the binding site, are a successful alternative to tamoxifen as a first-line therapy in postmenopausal women. However, several clinical trials in postmenopausal breast cancer patients and healthy postmenopausal women treated with AIs evaluated the risks of bone fractures. "
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