Duration of adjuvant endocrine therapy for pre- and postmenopausal women with hormone receptor-positive breast cancer.

[DrMetal]

I'm trying to understand this, can somebody tell me if this is right:

Assume a diagnosis of Estrogen-R positive breast cancer, assume menopause occurs at age 51 (post MP after 51). Assuming tolerating treatment well, no adverse reactions/events, no re-occurrence.

Scenario: diagnosed at age 39-yo:
| 39yo <-------WOULD GET TAMOXIFEN------> 49yo <--- NOTHING --> 51yo <--- WOULD GET AI ---> 56yo . DONE
So in other words, would get 10 years of tamoxifen, then nothing until post MP, then 5 years of an AI. Is this right? (seems like a lot--15 years of therapy--but I guess it might make sense of such a young diagnosis. OR, would she get the tamoxifen all the way up until MP (12 years of it), then AI for 5 additional years?

Scenario: diagnosed at age 46-yo:
| 46yo <-------WOULD GET TAMOXIFEN------> 51yo <--- WOULD GET AI ---> 56yo . DONE
So 5 years tamoxifen + 5 years AI.

Scenario: diagnosed at age 52-yo: MP was at 51,
52yo <--- WOULD GET AI ---> 62yo . DONE
so 10 years of an AI? (I know it used to be 5 years post MP, but now doing 10?)

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[gutonc]

Are you trying to understand it for the boards? Or just second guessing your local oncologist?

Because the answer is....(wait for it)....it depends.

Short answer is that there is no data for more than 10 years of therapy for anyone.

For your first example, it depends on the clinicopathologic and genomic characteristics of the tumor.

pT1a/bN0, Grade 1, OncoType Low: I'd give 5y of tamoxifen and call it good
pT3N1, Grade 3, High MammaPrint and got ddAC-T chemo? She's getting ovarian suppression/oophorectomy and an AI for 7-10 years.

For the others, again...it depends but your answers aren't wrong.

If you're answering board question, it's 10 years. Would that life was so simple.

 

[DrMetal]

Are you trying to understand it for the boards? Or just second guessing your local oncologist?

Nah, for boards, was reading MKSAP. Thanks!

 

[gutonc]

Nah, for boards, was reading MKSAP. Thanks!

10 years.

Although at this point, the SOFT/TExT data has been out long enough that OS+AI should be an answer for #1.