Premenopausal Breast Cancer: Exemestane Found Superior to Tamoxifen in Estrogen Positive Disease

Dr. Olivia Pagani Institute of Oncology of Southern Switzerland Ospedale San Giovanni, Switzerland Interview with: 

Dr. Olivia Pagani
Clinical Director of the Breast Unit of Southern Switzerland
Ospedale San Giovanni, Switzerland

Medical Research: What are the main findings of the study?

Dr. Pagani: The study showed that the aromatase inhibitor Exemestane is superior to Tamoxifen (both given together with ovarian function suppression) in preventing breast cancer recurrence in premenopausal women with oestrogen receptor positive early breast cancer.

Medical Research: Were any of the findings unexpected?

Dr. Pagani: We designed the 2 studies (SOFT and TEXT) to confirm the results achieved with aromatase inhibitors in menopausal women and in fact the  benefit, in terms of disease free survival, is in the same range of that seen in postmenopausal women with aromatase inhibitors.

Medical Research: What should clinicians and patients take away from your report?

Dr. Pagani: The combination of an aromatase inhibitor (in our study Exemestane) and ovarian function suppression is a very effective treatment option in this population of patients. In women for whom ovarian function is indicated, Exemestane should be preferred to . In addition, overall survival at 5 years is excellent in both treatments groups, and also in women who do not receive chemotherapy, which is a very important information for young women with oestrogen receptor positive breast cancer.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Pagaini: The SOFT trial will also answer (by the end of the year) the pending question of the added benefit of ovarian suppression in patients receiving tamoxifen. All these data will allow to better tailor treatment decisions in our individual patients. We will also deeply analyse our data to see if any patients’ or disease characteristics are associated with better outcome or different toxicity profile.


Adjuvant Exemestane with Ovarian Suppression in Premenopausal Breast Cancer

Olivia Pagani, M.D., Meredith M. Regan, Sc.D., Barbara A. Walley, M.D., Gini F. Fleming, M.D., Marco Colleoni, M.D., István Láng, M.D., Henry L. Gomez, M.D., Carlo Tondini, M.D., Harold J. Burstein, M.D., Edith A. Perez, M.D., Eva Ciruelos, M.D., Vered Stearns, M.D., Hervé R. Bonnefoi, M.D., Silvana Martino, D.O., Charles E. Geyer, Jr., M.D., Graziella Pinotti, M.D., Fabio Puglisi, M.D., Diana Crivellari, M.D., Thomas Ruhstaller, M.D., Eric P. Winer, M.D., Manuela Rabaglio-Poretti, M.D., Rudolf Maibach, Ph.D., Barbara Ruepp, Pharm.D., Anita Giobbie-Hurder, M.S., Karen N. Price, B.S., Jürg Bernhard, Ph.D., Weixiu Luo, M.S., Karin Ribi, Ph.D., Giuseppe Viale, M.D., Alan S. Coates, M.D., Richard D. Gelber, Ph.D., Aron Goldhirsch, M.D., and Prudence A. Francis, M.D. for the TEXT and SOFT Investigators and the International Breast Cancer Study Group

N Engl J Med 2014; 371:107-118July 10, 2014DOI: 10.1056/NEJMoa1404037


Last Updated on July 10, 2014 by Marie Benz MD FAAD