ATLAS: In Practice

February 27, 2013 at 9:26 pm 6 comments

Judy

Dr. Judy Garber

Dr. Judy Garber is a medical oncologist specializing in breast cancer care at the Dana-Farber Cancer Institute in Boston. BCT spoke with Dr. Garber about how the ATLAS findings will affect breast cancer patients.

Q: Why were people surprised at the finding?

A: I was surprised so many people were surprised. The reason I say that is we have data from the MA-17 study, which looked at women who had had five years    of tamoxifen and then went on an AI or a placebo for five more years. That study was stopped early because the additional two years of medication (aromatase inhibitor) showed a profound effect on recurrence, so we started putting women on five years of an AI after five years of tamoxifen.

Our concern was for women who were premenopausal, whose only option was tamoxifen. We didn’t have any data saying that it was safe or effective for them to stay on tamoxifen longer. Now, we do.

The challenge is trying to figure out for whom this applies. The study included women who were at low and high risk of recurrence and it’s unlikely that additional tamoxifen will benefit everyone equally.  The hope would be that it really benefits those who are highest risk that their breast cancer will return. For women who are at low risk of recurrence, we try to make certain that the side effects will not outweigh the benefits over time.

Q: What about women who stopped taking tamoxifen years ago?

A: I think any woman who has concerns after years off tamoxifen should talk to her doctor about all of this. The study was about continuous tamoxifen use.  If the cancer was long ago and a woman hasn’t had a recurrence, it may not be necessary to consider more tamoxifen, but that should be an individual decision.

Q: How will these findings change breast cancer care?

A: The practice in the U.S. has been five years of tamoxifen—or less in postmenopausal women who might do two-to-three years on tamoxifen and then switch to an AI – based on older data from the NSABP.

It didn’t make sense that ten years of hormonal therapy was better in women after menopause, but only five years was better in premenopausal women.  Therefore, this study will encourage longer duration of tamoxifen therapy in premenopausal women at higher risk of recurrence.  I think this study should also reassure women who took tamoxifen in the past that it is a good and active drug. The challenge will be to identify those women who need 10 years of tamoxifen and those who will get all the benefit they need with 5 years.

If you have any questions about your treatment, you should talk to your doctor. There also are things a woman can do like exercising, minimizing alcohol intake and losing weight that can help reduce risk if she has a hormone receptor positive tumor. Not everyone needs 10 years of tamoxifen. But for those who do need it it’s helpful to know that it can be given safely and that there is additional benefit.

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Entry filed under: Personal Stories, Research Results.

Calendar/Events ATLAS: When Research Changes Practice

6 Comments Add your own

  • 1. Pamela Stephens  |  March 1, 2013 at 7:51 pm

    If a post-menopausal woman takes an Aromatase Inhibitor for 5 years, should she then take tamoxifen for an additional 5 years?

    Reply
  • 2. breastcancertrials  |  March 1, 2013 at 10:58 pm

    Hi Pamela: This is an excellent question. I’m sure others have the same question as well. As Dr. Garber says, we recommend that women discuss treatment options with their physicians.

    Reply
    • 3. Pamela Stephens  |  March 2, 2013 at 2:00 am

      A referral to medical literature BEFORE I see my oncologist next week would be helpful. The more I know, the better my questions, and the better my understanding of my doctor’s answers. I have been taking Arimidex for almost 5 years; decision time is fast approaching. Of course there are always miriad treatment options to discuss (with all their pros and cons); an informed patient makes a good patient.

      Reply
      • 4. breastcancertrials  |  March 5, 2013 at 12:38 am

        Here is a link to ASCO’s Decision Aid For Adjuvant Hormone Therapy. It compares the risks and benefits of AI’s and Tamoxifen. It came out before the ATLAS results (in 2010), so it may not directly answer your question, but it may be helpful as you prepare to talk to your doctor: http://bit.ly/YK4dn1

  • 5. anne vincent  |  March 3, 2013 at 1:26 am

    This research addresses the advantages of longer-term hormonal therapy in terms of decreased recurrences of breast cancer. This oncologist has the good grace to mention the issue of side effects of either tamoxifen or AI’s, when used for the additional 5 years. Where is the study of long-term (not merely the side-effects noticed at the time when the medication is being taken) consequences? Estrogen is known to have a significant role in the brain. Is it possible that prolonged utilization of an estrogen inhibitor or blocker will provoke deleterious changes in our brains? (Is it possible that more women who take these medications for the additional 5 years will develop dementia?) These are the types of questions that the oncology studies tend to ignore, since the priorities of the specialty seem to be more focused upon survival. As patients we need to demand a more “whole patient welfare” approach to research, as well as the recommendations from oncologists. Since the long-term consequences of another five years of estrogen are not yet known, I would suggest that oncologists need to be very honest with patients about this issue. Increasing our survival, if we have developed dementia, may not be considered advantageous.

    Reply
  • 6. breastcancertrials  |  March 5, 2013 at 12:36 am

    Reply

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