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Recommendation
Endocrine therapy with aromatase inhibitors – Duration of therapy #1
Offer extended therapy (total duration of endocrine therapy of more than 5 years) with an aromatase inhibitor for postmenopausal women with ER-positive breast cancer who are at intermediate or high risk of late recurrence and who have been taking tamoxifen for 2 to 5 years.
Offer extended therapy (total duration of endocrine therapy of more than 5 years) with an aromatase inhibitor for postmenopausal women with ER-positive invasive breast cancer who are at medium or high risk of disease recurrence and who have been taking tamoxifen for 2 to 5 years
Women with low-risk node-negative tumors should not routinely be offered extended therapy.
Women with node-positive breast cancer should be offered extended AI therapy for up to a total of 10 years of adjuvant endocrine treatment.
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How this guidance was developed
This recommendation was adopted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording (‘Offer’) indicative of a strong recommendation (using GRADE methods) by the source guideline authors. The source recommendation was accepted with no changes.
For noting: In response to stakeholder feedback on the NICE (2018) phrase ‘Offer extended therapy (total duration of endocrine therapy of more than five years)…’ as being too vague, NICE (2018) noted that there is evidence suggesting that 7-8 years is enough, and that 10 years may not be needed; however the evidence review focused on a comparison of durations longer than 5 years against 5 years of endocrine therapy. NICE (2018) further noted that there were no clear results based on the durations of the included studies, so the committee did not think it possible to make recommendations on the absolute duration of therapy or the endpoint.
The inclusion of ‘who have been taking aromatase inhibitors for 2 to 5 years’ in the NICE (2018) source recommendation reflects that many patients receiving tamoxifen switch to an AI after 2-3 years.
For noting: In response to feedback during the stakeholder consultation that there should be ‘a statement on use of extended endocrine therapy in postmenopausal women who have been taking an AI for 5 years’, NICE (2018) indicated that there was insufficient evidence to do so.
The ASCO 2018 focused-update guideline on use of AIs and the relevant recommendation on extended AI therapy is also noted.
Endocrine therapy with aromatase inhibitors – Duration of therapy #1
Recommendation
Offer extended therapy (total duration of endocrine therapy of more than 5 years) with an aromatase inhibitor for postmenopausal women with ER-positive breast cancer who are at intermediate or high risk of late recurrence and who have been taking tamoxifen for 2 to 5 years.
Principles in action
Patient-centred care
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Safe and quality care
Useful Links
This recommendation was adopted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording (‘Offer’) indicative of a strong recommendation (using GRADE methods) by the source guideline authors. The source recommendation was accepted with no changes.
For noting: In response to stakeholder feedback on the NICE (2018) phrase ‘Offer extended therapy (total duration of endocrine therapy of more than five years)…’ as being too vague, NICE (2018) noted that there is evidence suggesting that 7-8 years is enough, and that 10 years may not be needed; however the evidence review focused on a comparison of durations longer than 5 years against 5 years of endocrine therapy. NICE (2018) further noted that there were no clear results based on the durations of the included studies, so the committee did not think it possible to make recommendations on the absolute duration of therapy or the endpoint.
The inclusion of ‘who have been taking aromatase inhibitors for 2 to 5 years’ in the NICE (2018) source recommendation reflects that many patients receiving tamoxifen switch to an AI after 2-3 years.
For noting: In response to feedback during the stakeholder consultation that there should be ‘a statement on use of extended endocrine therapy in postmenopausal women who have been taking an AI for 5 years’, NICE (2018) indicated that there was insufficient evidence to do so.
The ASCO 2018 focused-update guideline on use of AIs and the relevant recommendation on extended AI therapy is also noted.