Endocrine Therapy for Ductal Carcinoma In Situ (DCIS) of the Breast with Breast Conserving Surgery (BCS) and Radiotherapy (RT): a Meta-Analysis
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The management of ductal carcinoma in situ (DCIS) with endocrine therapy remains controversial. A meta-analysis was conducted to evaluate the role of endocrine therapy for DCIS with breast conserving surgery (BCS) and radiotherapy (RT). A total of 7 articles with randomized controlled trials were included. Five articles compared the effects of BCS and RT followed by tamoxifen (TAM) or not (BCS + RT + TAM vs BCS + RT) and 2 compared the effects of TAM and anastrozole (ANA). TAM obviously reduced the rates of recurrence of ipsilateral breast cancer (IBCR), recurrence of contralateral breast cancer (CBCR), recurrence of ipsilateral invasive breast cancer (IBCR-INV) and recurrence of contralateral DCIS (CBCR-DCIS), and increased the rate of event-free survival (EFS). While ANA reduced the rates of CBCR and recurrence of contralateral invasive breast cancer (CBCR-INV). Patients with ANA had higher incidence of arthralgia, osteoporosis, hypercholesteremia, headache and vaginal dryness, but lower incidence of deep-vein thrombosis, pulmonary embolism, vasomotor or gynaecological, hot flushes, vaginal haemorrhage, vaginal discharge and vaginal candidiasis than TAM. In conclusion, DCIS patients with positive hormone receptors should be recommended to receive endocrine therapy. Selection of TAM or ANA is based on clinical characteristics and underlying disease of patients, as well as the side-effects of drugs.
KeywordsDuctal carcinoma in situ (DCIS) Endocrine therapy Meta-analysis
The work was supported by the National Natural Science Foundations of China (Juan Ren, 81772793/H1621, Juan Ren, 31201060/C0709; Juan Ren,30973175/C1701; and Juan Ren, 81172490/H1621); Program for New Century Excellent Talents in University (Juan Ren, NCET-12-0440); Scientific and Technological Research Foundation of Shaanxi Province (Juan Ren, 2012 K13-01-06); Research Foundation of Health Department of Shaanxi Province (Juan Ren, 2010D41); Qing Nian Jiao Shi Gen Zong Ji Hua of Xi’an Jiaotong University (“The Fundamental Research Funds for the Central Universities”) (Juan Ren, 2012). Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (Juan Ren, No. XJTU1AHCR2014-041).
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Conflict of Interest
The author reports no conflicts of interest in this work.
- 2.Torre LA, Sauer AM, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL (2016) Cancer statistics for Asian Americans, native Hawaiians, and Pacific islanders, 2016: converging incidence in males and females. CA Cancer J Clin 66:182–202. https://doi.org/10.3322/caac.21335 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, Forbes JF, Bishop H, Fentiman IS, George WD (2011) Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 12(1):21–29. https://doi.org/10.1016/S1470-2045(10)70266-7 CrossRefPubMedGoogle Scholar
- 9.Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, Sahmoud T, Group AT (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359(9324):2131–2139CrossRefGoogle Scholar
- 10.Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS, Group AT (2005) Results of the ATAC (Arimidex, tamoxifen, alone or in combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 365(9453):60–62. https://doi.org/10.1016/S0140-6736(04)17666-6 CrossRefPubMedGoogle Scholar
- 11.Breast International Group 1-98 Collaborative G, Thurlimann B, Keshaviah A, Coates AS, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Rabaglio M, Smith I, Wardley A, Price KN, Goldhirsch A (2005) A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 353(26):2747–2757. https://doi.org/10.1056/NEJMoa052258 CrossRefGoogle Scholar
- 13.Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N (2015) Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 387:849–856. https://doi.org/10.1016/S0140-6736(15)01168-X CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones L, Ellis I, Cuzick J, investigators I-I (2015) Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet. https://doi.org/10.1016/S0140-6736(15)01129-0 CrossRefGoogle Scholar
- 15.KF S, DG A, D M, Group C (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 8(5):18Google Scholar
- 17.Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, Smith R, Begovic M, Dimitrov NV, Margolese RG, Kardinal CG, Kavanah MT, Fehrenbacher L, Oishi RH (1999) Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and bowel project B-24 randomised controlled trial. Lancet (London, England) 353(9169):1993–2000. https://doi.org/10.1016/S0140-6736(99)05036-9 CrossRefGoogle Scholar
- 19.Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, Land SR, Margolese RG, Swain SM, Costantino JP, Wolmark N (2011) Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 103(6):478–488. https://doi.org/10.1093/jnci/djr027 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, Mamounas EP, Julian TB, Geyer CE Jr, Costantino JP, Land SR, Wolmark N (2012) Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 30(12):1268–1273. https://doi.org/10.1200/JCO.2010.34.0141 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, Forbes JF (2010) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 11(12):1135–1141. https://doi.org/10.1016/s1470-2045(10)70257-6 CrossRefPubMedGoogle Scholar
- 24.Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies (2015). The Lancet 385 (9980):1835–1842. https://doi.org/10.1016/s0140-6736(14)61687-1