ER+ breast cancer: tamoxifen benefit extends 15 years for luminal A subtype

  • Yu NY & al.
  • JAMA Oncol
  • 8 Aug 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Tamoxifen therapy is associated with a 15-year benefit in luminal A breast cancer, whereas its benefit is shorter, at 5 years, for luminal B tumors.

Why this matters

  • Risk for distant metastasis persisted for 25 years postdiagnosis with luminal A tumors but attenuated at 5 years for luminal B disease.

Study design

  • Secondary analysis of the Stockholm Tamoxifen (STO-3) trial (originally 1976-1990) conducted at 25 years in postmenopausal patients with estrogen receptor (ER)-positive, node-negative breast cancer.
  • Tamoxifen (vs no tamoxifen) was randomly assigned to patients for ≥2 years; patients who were recurrence-free were further randomly assigned to 3 more years of tamoxifen vs no tamoxifen.
  • Primary outcome was distant recurrence-free interval.
  • Funding: Swedish Research Council; others.

Key results

  • Luminal A group (183 treated, 153 untreated): patients benefited for 15 years postdiagnosis (HR, 0.57; 95% CI, 0.35-0.94) but remained at risk for distant metastasis throughout the 25-year follow-up.
  • Luminal B group (64 treated, 62 untreated): patients benefited for 5 years (HR, 0.38; 95% CI, 0.24-0.59), at which point the risk for distant metastasis attenuated.

Limitation

  • Duration of tamoxifen treatment unreported.
  • Treatments have changed since trial start.

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