Aromatasehemmer in der endokrinen Therapie des Mammakarzinoms

Aromatase inhibitors have replaced tamoxifen as first choice in postmenopausal women with steroid receptor-positive disease. A series of prospective randomized trials demonstrated that anastrozole, letrozole, and exemestane are superior to tamoxifen in terms of therapy response, progression-free survival, and overall survival. Recent large clinical trials have examined these therapeutic agents in the adjuvant setting. The ATAC trial demonstrated that anastrozole significantly reduces both the rates of local and distant recurrences among women with steroid receptor-positive disease in comparison to tamoxifen. Two other large clinical trials examined the sequential use of tamoxifen and letrozole and exemestane. After a median follow-up of 2.4 years, letrozole proved superior in terms of recurrences. Also, exemestane after tamoxifen leads to a significant reduction of recurrences and contralateral breast cancers. There was no difference in overall survival in both studies.