Highlights from the San Antonio breast cancer symposium 2011

摘要

Question 1: How Do the New Results on Bisphospohnates Change Your Thinking and Daily Clinical Practice When Dealing With Adjuvant Therapy of Premenopausal and Postmenopausal Patients With Breast Cancer? Dubsky: I am a co-author of the ABCSG 12 study and have been working very close to these data for several years. It has been quite remarkable to witness how well the data have matured, the hazard ratios (HRs) have kept stable and it is now of course a further credit to the study to show a significant overall survival advantage. In Austria, 3 years of goserelin in combination with tamoxifen has been a standard endocrine therapy for most oncologists ever since publication of the ABCSG 5 results and the start of ABCSG 12 over a decade ago. Currently, we are using zoledronic acid (ZOL) 4 mg every 6 months for 3 years to treat women that fit the inclusion criteria of ABCSG 12. This means that estrogen receptor positive (ER+) premenopausal patients not assigned to chemotherapy receive adjuvant ZOL on the basis of the ABCSG 12 data and its publication. We are well aware that this schedule is not a standard therapy in other parts of the world - and this makes the adjuvant use of ZOL limited. Concerning the use of ZOL in postmenopausal women there are currently insufficient data to recommend its use as an adjuvant therapy. Although the subset analysis of AZURE showing both disease free survival (DFS) and overall survival (OS) advantages for postmenopausal women is very impressive (and comprises the largest group of women that we treat!), the overall study is negative. However, especially postmenopausal women treated with aromatase inhibitors (AI) show high rates of bone loss; several guidelines recommend the use of bisphosphonates in this indication.