Randomized trials of tamoxifen vs. AIs in the adjuvant breast cancer setting
| Clinical trial comparison(s) | N. of cases(menopausal status) | Follow (years)up | Overall results | Predictive effects by BMI | References |
|---|---|---|---|---|---|
| ATACA vs. T | 4,939 (post) | 8.3 | A better than T | A better than T at all BMI levelsA less effective when BMI ≥ 30 for DDFSA relative benefit of A vs. T when BMI low | [7] |
| TEAME vs. T → E | 4,700 (post) | 5.1 | E = T95% CI (0.39–0.84) | E better than T (2.75 years) at all BMI levels, significant in BMI > 30 (DDFS HR = 0.57, 95% CI = 0.39–0.84)E better than T → E (5.1 years) for any BMI (ns), BMI > 30 (DDFS HR = 0.75, 95% CI = 0.56–1.01 and OS HR = 0.71, 95% CI = 0.51–1.01) | [10] |
| ABCSG-12A + G vs. T + G | 1,684 (pre) | 5.2 | A + G = T + G (DFS)A + G worse than T + G (OS) | BMI < 25: A = T (DFS, OS)BMI ≥ 25: A worse than THR = 1.49, 95% CI = 0.93–2.03 (DFS)HR = 3.03, 95% CI = 1.35–6.82 (OS) | [8] |
| BIG 1–98L vs. T vs.L → T vs. T → L | 4,760 (post) | 8.7 | L better than T(DFS, DDFS, OS)L → T or T → L = L | Treatment by BMI interactions (ns)L vs. T HR: 0.77 NW, 0.68 OW, 0.78 OB | [11] |
N.: number of cases; A: anastrozole; T: tamoxifen; L: letrozole; E: exemestane; G: goserelin; T → E: tamoxifen followed by exemestane; L → T: letrozole followed by tamoxifen; T → L: tamoxifen followed by letrozole; BIG 1–98: breast international group 1–98 trial; NW: normal weight; OW: overweight; OB: obese; DDFS: distant disease-free survival; DFS: disease-free survival; OS: overall survival; ns: not significant