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Objectives

Objectives. Adjuvant tamoxifen duration ( S1-2) Adjuvant trastuzumab duration ( S5-2) Adjuvant chemotherapy for isolated local regional recurrence ( S3-2) Role of bevacizumab ? ( S1-7, S6-5).

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Objectives

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  1. Objectives • Adjuvant tamoxifen duration (S1-2) • Adjuvant trastuzumab duration (S5-2) • Adjuvant chemotherapy for isolated local regional recurrence (S3-2) • Role of bevacizumab? (S1-7, S6-5)

  2. Figure 5 Effects of about 5 years of tamoxifen on the 15-year probabilities of recurrence and of breast cancer mortality, for ER-positive disease Outcome by allocated treatment in trials of about 5 years of adjuvant tamoxifen. Event rate ratio (... Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials The Lancet Volume 378, Issue 9793 2011 771 - 784 http://dx.doi.org/10.1016/S0140-6736(11)60993-8

  3. ATLAS • Very large, pragmatic study (1996-2005) • No restrictions on age, hormone receptor status, nodal status or other treatments • No protocol-defined visits or evaluations except for yearly MD questionnaire • Protocol amended in 2000 when 5 years of tamoxifen was superior to 2 years Published online Lancet 12/5/12

  4. Table 1, ER+ tumors

  5. Figure 3 Recurrence (A) and breast cancer mortality (B) by treatment allocation for 6846 women with ER-positive disease Bars show SE. Recurrence rates are percentage per year (events/patient-years of follow-up). Death rates (overall rate???rate ... Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V... Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial The Lancet null 2012 null http://dx.doi.org/10.1016/S0140-6736(12)61963-1

  6. Figure 2 Treatment compliance (A) and proportion of patients in follow-up (B) by year since randomisation for 6846 women with ER-positive disease (54% node-negative) *>99% tamoxifen. Christina Davies , Hongchao Pan , Jon Godwin , Richard Gray , Rodrigo Arriagada , Vinod Raina , Mirta Abraham , V... Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial The Lancet null 2012 null http://dx.doi.org/10.1016/S0140-6736(12)61963-1

  7. How does this impact clinical care? • For patients who are appropriate candidates for tamoxifen therapy, 10 years of tamoxifen is recommended. • This trial cannot be compared to any strategies that have incorporated aromatase inhibitors.

  8. How does this impact clinical care? • One year of adjuvant trastuzumab remains the standard of care. • PHARE trial (abstract #S5-3) was a subset analysis of non-inferiority of 6 versus 12 months of adjuvant trastuzumab.

  9. How does this impact clinical care? • A course of adjuvant chemotherapy after an isolated local regional recurrence improves DFS and OS. • The benefits appear less convincing for hormone receptor positive disease. • Sites of recurrence (ipsilateral breast versus chest wall) and timing of recurrence and their correlation with outcomes were not reported in detail.

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