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New UK breast cancer guidelines confirm preference for switch strategy

The 2007 St Gallen Guidelines reveal that breast cancer experts support switching from tamoxifen to an aromatase inhibitor for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer

The 2007 St Gallen Guidelines reveal that breast cancer experts from around the world support switching from tamoxifen to an aromatase inhibitor (AI) for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer.

These new guidelines come in the wake of last year's NICE guidance in which Pfizer's Aromasin (exemestane) is the only treatment option recommended as an alternative to continued tamoxifen for women who have already received two to three years of initial adjuvant tamoxifen therapy.

The 2007 St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer is published today in the Annals of Oncology. The guidelines are based on a consensus of breast cancer experts from around the world. In hormone receptor positive breast cancer, the St Gallen panel expressed a clear preference for switching patients from tamoxifen to an AI after two to three years of tamoxifen. 

The Intergroup Exemestane Study (IES) published in The Lancet earlier in 2007, showed an overall survival benefit for women who switched to exemestane after two to three years of tamoxifen, making exemestane the only AI to have demonstrated overall survival in a single, double-blind switching trial. 

The IES, which randomized 4,724 patients across 37 countries, demonstrated that postmenopausal women with oestrogen receptor positive early breast cancer, who switched to exemestane after two to three years of tamoxifen, experienced a 17 per cent reduction in the risk of death compared to those who stayed on tamoxifen for the full five years of therapy. Exemestane was the first AI to receive approval in the switch setting.

7th August 2007

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