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Brustkrebs - Prävention: Studien

Metaanalyse (2)

In Risikokollektiven postmenopausaler Frauen lässt sich die Brustkrebs-Inzidenz durch SERM senken.

Studien

Studie

Serm

Vergleich Patienten Bemerkungen

NSABP-P1 (7)

20mg Tamoxifen 5a

Placebo 13.388 ER-positive Tumoren werden reduziert (HR 0,51). ER-negative Tumoren nicht beeinflusst.

IBIS-I (5,6)

20mg Tamoxifen 5a

Placebo 7.139 ER-positive Tumoren werden reduziert (HR 0,73). ER-negative Tumoren nicht beeinflusst.

Marsden (3,4)

20mg Tamoxifen 8a

Placebo 2.471 ER-positive Tumoren werden reduziert (HR 0,78). ER-negative Tumoren nicht beeinflusst.

Veronesi (9,10)

20mg Tamoxifen 5a

Placebo 5.408 Tumoren werden reduziert (HR 0,84). High-risk: HR 0,24. Nach postmenopausaler Östrogengabe: HR 0,43

NSABP STAR (14,15)

60mg Raloxifen 5a

20mg Tamoxifen 19.747 Mehr invasive Karzinome unter Raloxifen (HR 1,24). Mehr DCIS unter Raloxifen.

NCIC-CTG-MAP.3 (1)

25 mg Exemestan 5a

Placebo 4.560 ER-positive Tumoren werden reduziert (HR 0,35). ER-negative Tumoren nicht beeinflusst.

IBIS-II (20,22)

1 mg Anastrozol 5a

20mg Tamoxifen 3.864 Mehr invasive Karzinome unter Tamoxifen (HR 0,47). ER-negative Tumoren nicht beeinflusst.

MORE (23)

Raloxifene

Placebo

7,705

CORE (24)

Raloxifene

Placebo

7,705

RUTH (25)

Raloxifene

Placebo

10,101

PEARL (26)

Lasofoxifene

Placebo

5,704

Generations (27, 28)

Arzoxifene

Placebo

9,354

 

NCIC-CTG-MAP.3 (1)

Der Aromatase-Inhibitor Exemestan führt zu einer 65 %igen Risiko-Reduktion für Brustkrebs nach einem medianen Follow-up von 3 Jahren.

NNT (Number needed to treat): 94 (3 Jahre), 26 (über 5 Jahre).

Quellen

1.) Goss PE, et al.:
Exemestane for breast-cancer prevention in postmenopausal women.
NEJM 364(2011): 2381–91

2.) Cuzick J, et al.:
Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data.
Lancet 2013; e-pub before print: doi: 10.1016/S0140-6736(13)60140-3.

3.) Powles T, et al.:
Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial.
Lancet 352 (1998): 98–101

4.) Powles TJ, et al.:
Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial.
J Natl Cancer Inst 99 (2007): 283–290

5.) Cuzick J, et al.:
First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial.
Lancet 360 (2002): 817–824

6.) Cuzick J, et al.:
Long-term results of tamoxifen prophylaxis for breast cancer—96-month follow-up of the randomized IBIS-I trial.
J Natl Cancer Inst 99 (2007): 272–282

7.) Fisher B, et al.:
Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.
J Natl Cancer Inst, 90 (1998): 1371–1388

8.) Fisher B, et al.:
Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study.
J Natl Cancer Inst 97 (2005):1652–1662

9.) Veronesi U, et al.:
Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Italian Tamoxifen Prevention Study.
Lancet 352 (1998): 93–97

10.) Veronesi U, et al.:
Tamoxifen for the prevention of breast cancer: late results of the Italian Randomized Tamoxifen Prevention Trial among women with hysterectomy.
J Natl Cancer Inst 99 (2007): 727–737

11.) Cauley JA, et al.:
Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation.
Breast Cancer Res Treat 65 (2001):125–134

12.) Martino S, et al.:
Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene.
J Natl Cancer Inst 96 (2004): 1751–1761

13.) Barrett-Connor E, et al.:
Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.
N Engl J Med 355 (2006): 125–137

14.) Vogel VG, et al.:
Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 Trial.
JAMA, 295 (2006): 2727–2741

15.)Vogel VG, et al.:
Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: preventing breast cancer.
Cancer Prev Res 3 (2010): 696–706

16.) Cummings SR, et al.:
Lasofoxifene in postmenopausal women with osteoporosis.
N Engl J Med 362 (2010): 686–696

17.) LaCroix AZ, et al.:
Breast cancer incidence in the randomized PEARL trial of lasofoxifene in postmenopausal osteoporotic women.
J Natl Cancer Inst 102 (2010): 1706–1715

18.) Cummings SR, et al.:
Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women.
J Bone Miner Res 26 (2011): 397–404

19.) Powles TJ, et al.:
Breast cancer incidence in postmenopausal women with osteoporosis or low bone mass using arzoxifene.
Breast Cancer Res Treat 134 (2012): 299–306

20.) Cuzick J:
Aromatase inhibitors in prevention—data from the ATAC (arimidex, tamoxifen alone or in combination) trial and the design of IBIS-II (the second International Breast Cancer Intervention Study).
Recent Results Cancer Res 163 (2003): 96–103

21.) Goss PE, et al.:
Exemestane for breast-cancer prevention in postmenopausal women.
N Engl J Med 364 (2011): 2381–2391

22.) Cuzick J, et al.:
Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): An international, double-blind, randomised placebo-controlled trial.
Lancet 383(2014):1041-8. doi: 10.1016/S0140-6736(13)62292-8

23.) Cauley JA, Norton L, Lippman ME, et al.:
Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial.
Breast Cancer Res Treat 2001;65:125-34. [Erratum, Breast Cancer Res Treat 2001; 67:191.]

24.) Martino S, Cauley JA, Barrett-Connor E, et al.:
Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene.
J Natl Cancer Inst 2004;96:1751-61

25.) Barrett-Connor E, Mosca L, Collins P, et al.:
Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.
N Engl J Med 2006;355:125-37.

26.) LaCroix AZ, Powles T, Osborne CK, et al.:
Breast cancer incidence in the randomized PEARL trial of lasofoxifene in postmenopausal osteoporotic women.
J Natl Cancer Inst 2010;102: 1706-15.

27.) Cummings SR, McClung M, Reginster JY, et al.:
Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women.
J Bone Miner Res 2011;26:397-404.

28.) Powles TJ, Diem SJ, Fabian CJ, et al.:
Breast cancer incidence in postmenopausal women with osteoporosis or low bone mass using arzoxifene.
Breast Cancer Res Treat 2012;134:299-306.

 

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