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POC Breast 1 | 2007 -  	Adjuvant Endocrine Therapy
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POC Breast 1 | 2007 - Adjuvant Endocrine Therapy

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  • 1. Patterns of Care in Medical Oncology Adjuvant Endocrine Therapy
  • 2. What endocrine therapy, if any, would you recommend for a 55-year-old postmenopausal woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? 2007 2006 2005 Clinical investigators (CI) 0% 14% 2% 84% 2% 0% Other 16% 2% 82% 9% 0% 89% Tamoxifen for 2-3 years, then switch to an AI Tamoxifen for 5 years, then switch to an AI Al alone
  • 3. What endocrine therapy, if any, would you recommend for a 55-year-old postmenopausal woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? 2007 2006 2005 Practicing oncologists (PO) 5% 5% 6% 84% 7% 4% Other 8% 8% 80% 9% 4% 80% Tamoxifen for 2-3 years, then switch to an AI Tamoxifen for 5 years, then switch to an AI Al alone
  • 4. What endocrine therapy, if any, would you recommend for a 35-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? * If patient becomes postmenopausal 2007 2006 2005 Clinical investigators (CI) 2% 13% 2% Other 12% 0% 0% Tamoxifen for 2-3 years, then switch to an AI* 12% 12% 24% 38% 18% 22% AI + LHRH agonist or ovarian ablation 47% 9% 20% 42% 11% 16% Tamoxifen for 5 years, then no further treatment Tamoxifen for 5 years, then switch to an AI* Tamoxifen + LHRH agonist or ovarian ablation
  • 5. What endocrine therapy, if any, would you recommend for a 35-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? * If patient becomes postmenopausal 2007 2006 2005 Practicing oncologists (PO) 7% 12% 8% Other 15% 6% 4% Tamoxifen for 2-3 years, then switch to an AI* 17% 18% 24% 19% 11% 6% AI + LHRH agonist or ovarian ablation 52% 10% 20% 37% 13% 21% Tamoxifen for 5 years, then no further treatment Tamoxifen for 5 years, then switch to an AI* Tamoxifen + LHRH agonist or ovarian ablation
  • 6. What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative, node-negative tumor? * If patient becomes postmenopausal 7% 0% Other/no endocrine therapy Age 35, premenopausal 12% 12% 24% 52% 15% Tamoxifen + LHRH agonist or ovarian ablation 13% 29% 36% Tamoxifen for 2-3 years, then switch to an AI* Tamoxifen for 5 years, then switch to an AI* Tamoxifen for 5 years, then no further treatment Clinical investigators Practicing oncologists
  • 7. What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative, node-negative tumor? 7% 25% Tamoxifen for 2-3 years, then switch to an AI 5% 4% Other Age 55, postmenopausal 0% 20% 51% 5% Tamoxifen for 5 years, then switch to an AI 14% 69% Letrozole alone Anastrozole alone Clinical investigators Practicing oncologists
  • 8. What endocrine therapy do you generally recommend for postmenopausal women with ER-positive, HER2-negative, node-negative tumors? 2007 2005 2002 Practicing oncologists (PO) 14% 3% 14% 69% 26% 58% Tamoxifen 0% 3% 39% 2% 0% 72% Exemestane Letrozole Anastrozole
  • 9. When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI? 2007 2006 2005 Clinical investigators (CI) 4% 35% 61% 3% 11% 86% 3% 22% 75% Exemestane Letrozole Anastrozole
  • 10. When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI? 2007 2006 2005 Practicing oncologists (PO) 6% 27% 67% 3% 11% 86% 6% 23% 71% Exemestane Letrozole Anastrozole
  • 11. What percent of your patients on adjuvant AIs have significant arthralgias to the point that you consider discontinuing or switching agents ? 2007 2006 2005 9% 8% 5% Mean Practicing oncologists (PO) Clinical investigators (CI) 12% 10% 11% Mean
  • 12. What action would you take initially when you consider discontinuing or switching agents with patients who have significant arthralgias? 10% 0% 8% 82% 4% Other 0% 20% 76% Discontinue hormonal therapy Switch to tamoxifen Switch to another AI Clinical investigators Practicing oncologists
  • 13. What percent of your patients on adjuvant AIs have significant vasomotor symptoms to the point that you consider interventions such as SSRI antidepressants ? 2007 2006 2005 15% 19% 18% Mean Practicing oncologists (PO) Clinical investigators (CI) 16% 25% 23% Mean
  • 14. What action would you take initially when you consider interventions with the patients who have significant vasomotor symptoms? 1% 11% Other 0% 0% 4% 85% 1% Discontinue hormonal therapy 4% 15% 79% Switch to tamoxifen Switch to another AI Continue therapy and add an SSRI Clinical investigators Practicing oncologists
  • 15. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 1 year ago ? 2007 2006 2005 2% 5% 10% Use no further hormonal therapy 2% 2% 2% Start anastrozole 96% Clinical investigators (CI) 88% 93% Start letrozole
  • 16. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 1 year ago ? 2007 2006 2005 18% 13% 24% Use no further hormonal therapy 20% 24% 12% Start anastrozole 62% Practicing oncologists (PO) 64% 63% Start letrozole
  • 17. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 3 years ago ? 2007 2006 2005 29% 36% 80% Use no further hormonal therapy 0% 0% 0% Start anastrozole 71% Clinical investigators (CI) 20% 64% Start letrozole
  • 18. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 3 years ago ? 2007 2006 2005 58% 66% 76% Use no further hormonal therapy 12% 6% 6% Start anastrozole 30% Practicing oncologists (PO) 18% 28% Start letrozole
  • 19. Which of the following best describes the action you would take in the following scenarios? A 60-year-old woman was treated 8 years ago at age 52 (postmenopausal) for an ER-positive, PR-positive, HER2-negative, node-negative tumor. She received tamoxifen for 5 years and now presents for routine follow-up, doing well after being off tamoxifen for 3 years. 8% 29% 10% 53% 1% Other 59% 11% 29% Not recommend any endocrine therapy and continue with follow-up Recommend an aromatase inhibitor Discuss the option of an aromatase inhibitor but state that this would not be your recommendation Clinical investigators Practicing oncologists
  • 20. Which of the following best describes the action you would take in the following scenarios? A 60-year-old woman was treated 8 years ago at age 52 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/tamoxifen for 5 years and now presents for routine follow-up, doing well after being off tamoxifen for 3 years. 4% 6% 70% 20% 1% Other 47% 35% 17% Not recommend any endocrine therapy and continue with follow-up Recommend an aromatase inhibitor Discuss the option of an aromatase inhibitor but state that this would not be your recommendation Clinical investigators Practicing oncologists
  • 21. Which of the following would you recommend in the following scenarios? A 61-year-old woman was treated 5 years ago at age 56 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/anastrozole for 5 years and has tolerated therapy without major difficulties. Clinical investigators Practicing oncologists 4% 14% Other 25% 0% 25% 36% 25% Explain that few data exist to support either continuing or discontinuing endocrine therapy and ask which option the patient would prefer 5% 22% 44% Switch to another AI Continue anastrozole Stop anastrozole and give no further endocrine treatment
  • 22. Which of the following would you recommend in the following scenarios? An 81-year-old woman was treated 5 years ago at age 76 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/anastrozole for 5 years and has tolerated therapy without major difficulties. Clinical investigators Practicing oncologists 2% 4% Other 22% 0% 16% 58% 23% Explain that few data exist to support either continuing or discontinuing endocrine therapy and ask which option the patient would prefer 3% 15% 57% Switch to another AI Continue anastrozole Stop anastrozole and give no further endocrine treatment