HORMONAL TREATMENT

FOR POSTMENOPAUSAL
BREAST CANCER

368087 / July 2018

1
 Breast cancer is by far the most frequent cancer among women
with an estimated
1.6 million new cases diagnosed with more than 500,000
deaths each year
(GLOBOCAN 2012)

Ferlay J, et al. Cancer incidence and mortality worldwide : source, methods and major pattern in globocan 2012. IJC. 2014. 136: E358-E386
 Incidence and
mortality of breast
cancer is the biggest
among cancer in
Indonesia

3 International Agency for research on cancer. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx 2. downloaded 6/27/2016

Intrinsic subtype of breast cancer (St Gallen 2015) which is also recommended
by ESMO Clinical Practice Guidelines for making the prognosis and
treatment decision

4 Senkus E et al. Annals of Oncology. 2015. Downloaded from http://annonc.oxfordjournals.org/ at AZ Library on May 30, 2016
Treatment recommendation
for early breast cancer subtypes

Senkus E et al. Annals of Oncology. 2015. Downloaded from http://annonc.oxfordjournals.org/ at AZ Library on May 30, 2016

5
NCCN Guideline Version 2.2016
Adjuvant Endocrine Therapy For Postmenopausal Breast cancer

Aromatase inhibitors (AIs) and Tamoxifen are option for endocrine therapy for
post menopausal breast cancer patient.

6 NCCN Clinical practice guideline in oncology (NCCN Guidelines ). Version 2.2016. printed 6/2/2016
ARIMIDEX (anastrozole) :
Long term efficacyand tolerability
 ATAC Trial Design
9366 postmenopausal women with localised
invasive breast cancer

Surgery radiotherapy chemotherapy

Randomisation 1:1:1 for 5 years

Anastrozole Tamoxifen Combination

n=3125 n=3116 n=3125
Discontinued
Regular follow-up

Primary trial endpoints: Secondary trial endpoints:

Disease-free survival Incidence of contralateral breast cancer
Safety / tolerability Time to distant recurrence
Overall survival
Time to breast cancer death

ATAC Trialists' Group. Lancet Oncol. 2008; 9: 45-53

After 10 years of followup...
 ARIMIDEX upfront significanly reduces the risk of
recurrence by 21%

10 Cuzick J, et al. Lancet Oncol. 2010; 11:11351141

 ARIMIDEX upfront significantly reduces the time
to distant recurrence by 15%

11
Cuzick J et al. Lancet Oncol. 2010; 11:11351141
ARIMIDEX significantly reduces the risk of contralateral
breast cancer by 38% (HR=0,62 (0.450.85), p=0,003)

Cuzick J, et al. Lancet Oncol. 2010; 11:11351141

 ARIMIDEX is associated with lower incidence of
endometrial cancer compare with tamoxifen

p = 0.001

Tamoxifen Arimidex

13
Cuzick J, et al. Lancet Oncol. 2010; 11:11351141
ATAC 10 years tolerability profile

ARIMIDEX is proven to have a better tolerability profile in serious adverse

event than tamoxifen during treatment period. The increased fracture rate
with ARIMIDEX during treatment didnt continue after treatment.

Cuzick J, et al. Lancet Oncol. 2010; 11:11351141

 Lipid profile in premenopausal,
postmenopausal women and breast cancer
patient

15
Comparison of lipid profile in premenopausal
and postmenopausal women

Total cholesterol, triglycerides and LDLC

in postmenopausal significant higher
than premenopausal

Bade G et al. 2014. Downloaded free from http://www.cysonline.org on Tuesday, May 31, 2016.
 A case-control study conducted in 2001-2003 in department of
Surgical Oncology in New Delhi.

The study involved 160 patients diagnosed with breast cancer

which have not received any treatment specific for breast cancer

Total cholesterol level in breast cancer patients

Result significantly higher than control (p<0.001).

A significant difference (p=0.013) also observed

in triglyceride level of BC patients (170 67
mg/dL) vs control (149 81 mg/dL)

Kapil U et al. J Breast cancer. 2013 March ; 16(1) : 129130

ARIMIDEX is NOT the same with other AIs in
lipid profile
 1. Michallaki V, et al. Mollecullar and cellular biochemistry. 2005. 268 : 1924
2. Buzdar A, et al. Cancer. 2002 ; 95: 20062016
3. PI Arimidex version 22nd January 2014
4. Letrozole. PIO Nas (internet). http : //pionas.pom.go.id. Printed 6/27/2016
19 5. Aromasin. PIO Nas (internet). http://pionas.pom.go.id. Downloaded 6/27/2016
SUMMARY
ARIMIDEX as upfront adjuvant therapy is significantly more superior than
tamoxifen in reducing risk of recurrence, time to distant recurrence and
contralateral breast cancer1

ARIMIDEX associated with lower incidence of endometrial cancer compare

with tamoxifen1

ARIMIDEX is proven to have a better tolerability profile in serious

adverse event than tamoxifen during treatment period. The increased
fracture rate with ARIMIDEX during treatment didnt continue after
treatment1

ARIMIDEX is a non steroid aromatase inhibitor which has shown no

significant impact on patients lipid profile compared to other AIs2

1. Cuzick J, et al. Lancet Oncol. 2010; 11:11351141

20 2. Buzdar A, et al. Cancer. 2002 ; 95: 20062016