Journal of Clinical Oncology, Vol 19, Issue 14
(July), 2001: 3357-3366
© 2001 American Society for Clinical Oncology
Phase III, Multicenter, Double-Blind, Randomized Study of Letrozole, an Aromatase Inhibitor, for Advanced Breast Cancer Versus Megestrol Acetate
By A. Buzdar,
J. Douma,
N. Davidson,
R. Elledge,
M. Morgan,
R. Smith,
L. Porter,
J. Nabholtz,
X. Xiang,
C. Brady
From the University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine, Houston, TX; St Thomas Medical Group, Nashville, TN; Baptist Medical Center, Columbia, SC; Ziekenhuis Rijnstate, Arnhem, the Netherlands; North Middlesex Hospital, London, and St Margaret’s Hospital, Essex, United Kingdom; and Cross Cancer Institute, Edmonton, Alberta, Canada.
Address reprint requests to Aman Buzdar, MD, Department of Breast Medical Oncology, University of Texas M.D. Anderson Cancer Center, Box 424, 1515 Holcombe Blvd, Houston, TX 77030; email: abuzdar{at}mdanderson.org
PURPOSE: To compare two doses of letrozole (0.5 mg and 2.5 mg every day) and megestrol acetate (40 mg qid) as endocrine therapy in postmenopausal women with advanced breast cancer previously treated with antiestrogens.
PATIENTS AND METHODS: This double-blind, randomized, multicenter, multinational study enrolled 602 patients, all of whom were included in the primary analysis in the protocol. Patients had advanced or metastatic breast cancer with evidence of disease progression while receiving continuous adjuvant antiestrogen therapy, had experienced relapse within 12 months of stopping adjuvant antiestrogen therapy given for at least 6 months, or had experienced disease progression while receiving antiestrogen therapy for advanced disease. Tumors were required to be estrogen receptor– and/or progesterone receptor–positive or of unknown status. Confirmed objective response rate was the primary efficacy variable. Karnofsky Performance Status and European Organization for Research and Treatment of Cancer quality-of-life assessments were collected for 1 year.
RESULTS: There were no statistically significant differences among the three treatment groups for overall objective tumor response. Patients treated with letrozole 0.5 mg had improvements in disease progression (P = .044) and a decreased risk of treatment failure (P = .018), compared with patients treated with megestrol acetate. Letrozole 0.5 mg showed a trend (P = .053) for survival benefit when compared with megestrol acetate. Megestrol acetate was more likely to produce weight gain, dyspnea, and vaginal bleeding, and the letrozole groups were more likely to experience headache, hair thinning, and diarrhea.
CONCLUSION: Given a favorable tolerability profile, once-daily dosing, and evidence of clinically relevant benefit, letrozole is equivalent to megestrol acetate and should be considered for use as an alternative treatment of advanced breast cancer in postmenopausal women after treatment failure with antiestrogens.
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