Should aromatase inhibitors replace tamoxifen?

doi:10.1136/dtb.2003.41857

Drug and Therapeutics Bulletin 2003;41:57-59; doi:10.1136/dtb.2003.41857

Should aromatase inhibitors replace tamoxifen?

Relevant BNF section: 8.3.4.1

Six years ago, we reviewed the selective aromatase inhibitors,anastrozole and letrozole, for the treatment of women with breastcancer.¹ We concluded that anastrozole was at least as effectiveas megestrol (the standard treatment at that time for womenwith advanced postmenopausal breast cancer in whom tamoxifenhad failed), but that there was insufficient published evidenceto decide the place of letrozole in therapy. Since then, thesedrugs have become standard second-line treatment options forpostmenopausal women with locally advanced or metastatic, hormone-receptor-positivebreast cancer,² and a third selective aromatase inhibitor, ${blacktriangledown}$ exemestane(pronounced eks-ee-mes-tane), has been added to the market.Here we consider whether the aromatase inhibitors should replacetamoxifen as first-line therapy.