#july2020amc1
A 55-year-old post-menopausal woman has undergone a mastectomy and sentinel lymph node biopsy for a multi-focal invasive carcinoma of the left breast. She had two 2.5 cm diameter grade 2 invasive ductal carcinomas. Both tumors are strongly ER positive and her sentinel node was negative. Her tumor cells were PR positive and HER-2 negative. Which one of the following would be the most appropriate form of adjuvant hormonal therapy for this patient?
A. Anastrozole
B. Raloxifene
C. LHRH analogue
D. Tamoxifen
E. Toremifene
Explanatory Notes:
The patient is post-menopausal so ovarian supression with LH-RH analogues is not required.
Treatment with an aromatase inhibitor such as anastrozole provides better outcomes than the oestrogen receptor antogonist tamoxifen. Raloxifene, another ER antagonist, is only used to prevent and treat post-menopausal osteoporosis whilst toremifene, another ER antagonist, is used only in metastatic breast cancer. Compared with tamaoxifen, in the clinical case described, anastrozole will reduce the incidence of distant metastases and contralateral breast cancers. It will also delay the time to first recurrence thereby increasing disease free survival.
A 55-year-old post-menopausal woman has undergone a mastectomy and sentinel lymph node biopsy for a multi-focal invasive carcinoma of the left breast. She had two 2.5 cm diameter grade 2 invasive ductal carcinomas. Both tumors are strongly ER positive and her sentinel node was negative. Her tumor cells were PR positive and HER-2 negative. Which one of the following would be the most appropriate form of adjuvant hormonal therapy for this patient?
A. Anastrozole
B. Raloxifene
C. LHRH analogue
D. Tamoxifen
E. Toremifene
Explanatory Notes:
The patient is post-menopausal so ovarian supression with LH-RH analogues is not required.
Treatment with an aromatase inhibitor such as anastrozole provides better outcomes than the oestrogen receptor antogonist tamoxifen. Raloxifene, another ER antagonist, is only used to prevent and treat post-menopausal osteoporosis whilst toremifene, another ER antagonist, is used only in metastatic breast cancer. Compared with tamaoxifen, in the clinical case described, anastrozole will reduce the incidence of distant metastases and contralateral breast cancers. It will also delay the time to first recurrence thereby increasing disease free survival.
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