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Femara May Prevent Late Return of Breast Cancer

Researchers at Massachusetts General Hospital report good news for the drug, Femara (letrozole), used to prevent the recurrence of some forms of breast cancer, even when started long after the initial course of treatment has been discontinued.

Many women undergo surgery followed by treatment with tamoxifen for as long a five years. Many people, patients and physicians included, consider the five-year mark as the point beyond which cancer is unlikely to recur. In the case of breast cancer caused by hormone receptor-positive disease, however, the annual rate of recurrence of cancer never drops.

The Massachusetts General study, led by Paul E. Goss, MD, has identified letrozole, an aromatase inhibitor marketed by Novartis under the brand name Femara, as a viable preventive treatment for survivors of this type of breast cancer. Benefit has been measured when Femara treatment is started as long as seven years after discontinuing tamoxifen but the research team recommends it be started within three months of ending tamoxifen treatment.

Goss suggests hundreds of thousands of breast cancer patients could benefit from this treatment. Although the outlook is best for postmenopausal women who start Femara within three months of tamoxifen discontinuation when it was taken for early-stage breast cancer. It is also approved for treatment of active metastatic breast cancer when estrogen receptor status is either positive or unknown.

These findings are the result of a trial involving 5,187 women who had undergone tamoxifen treatment following the diagnosis of estrogen receptor-positive breast cancer. In the randomized trial, 2,383 women took placebos and the remainder received Femara. The study lasted five years.

One concern over Femara did surface during the trial, however. The women taking Femara experienced a higher rate of bone fractures (5.2%), leading to the diagnosis of osteoporosis, than the group taking placebo (3.1%).

The online Journal of Clinical Oncology carries full details of the study.

Paul E. Goss reported financial gains from the following: Pfizer, AstraZeneca, Novartis

• Is a study population of 5,000 enough to give these findings credibility? Should more studies be performed?

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