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Meta-analysis of pre-operative aromatase inhibitor versus tamoxifen in postmenopausal woman with hormone receptor-positive breast cancer

Authors
Seo, Jae HongKim, Yeul HongKim, Jun Suk
Issue Date
Jan-2009
Publisher
SPRINGER
Keywords
Meta-analysis; Aromatase inhibitor; Tamoxifen; Pre-operative; Breast cancer
Citation
CANCER CHEMOTHERAPY AND PHARMACOLOGY, v.63, no.2, pp 261 - 266
Pages
6
Indexed
SCIE
SCOPUS
Journal Title
CANCER CHEMOTHERAPY AND PHARMACOLOGY
Volume
63
Number
2
Start Page
261
End Page
266
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/120782
DOI
10.1007/s00280-008-0735-5
ISSN
0344-5704
1432-0843
Abstract
Purpose Clinical trials have reported conflicting results as to whether pre-operative aromatase inhibitors (AIs) improve outcome over pre-operative tamoxifen in postmenopausal women with hormone receptor-positive breast cancer. Methods We performed a meta-analysis comparing primary and secondary end points of pre-operative AI and pre-operative tamoxifen. The event-based risk ratio (RR) with 95% confidence intervals (95% Cis) were derived, and a test of heterogeneity was applied. Results Four studies (1,160 patients) met the inclusion criteria for the analysis. Meta-analysis showed that pre-operative AI was more effective than pre-operative tamoxifen. Pooled results of clinical efficacy were as follows: clinical objective response rate (RR, 1.29; 95% CI, 1.14-1.47; P < 0.001), ultrasound objective response rate (RR, 1.29; 95% CI, 1.10-1.51; P=0.002), and breast conserving surgery (BCS) rate ( RR, 1.36; 95% CI, 1.16-1.59; P < 0.001). Hot flashes, nausea, and fatigue were not different between the pre-operative AI and pre-operative tamoxifen groups. Although headache was more frequent in the pre-operative AI group (P=0.011), it was a manageable toxicity and was not clinically relevant. Conclusion Pre-operative AI has better BCS rate than tamoxifen and in terms of toxicities, is not inferior to tamoxifen; therefore, we could suggest pre-operative AI instead of tamoxifen for those postmenopausal patients with hormone receptor positive breast cancer, not eligible for chemotherapy.
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