Time to TEAM: exemestane, or tamoxifen then exemestane?

摘要

The TEAM trial, in The Lancet, reports the results of a large randomised trial in postmenopausal women with early breast cancer. The trial compared the steroidal aromatase inhibitor exemestane as monotherapy for 5 years with the sequence strategy of 2.5-3 years of tamoxifen followed by exemestane to complete a total of 5 years of endocrine therapy. Initially, the trial compared exemestane with tamoxifen monotherapy; however, this approach was altered to the current design after the Intergroup Exemestane Study showed, in 2004, significant improvement in disease-free survival with the switching strategy compared with tamoxifen monotherapy. Because the trial design assigned the treatment strategy at diagnosis, TEAM allows direct comparison of the monotherapy and sequential approaches to aromatase inhibitor administration. This amendment to the study was positive and worthwhile, enabling a recognised and important gap in the evidence base of aromatase inhibitor treatment to be filled.