One issue is that early treatment is often handled by urologists, not oncologists. And many urologists do not administer chemotherapy.
Dr. Morris said he did not think earlier use of docetaxel would diminish sales of the newer agents. Men will eventually become resistant to hormone therapy, he said, and will need the newer agents.
In breast cancer, women with estrogen-responsive disease typically take drugs for at least five years after their tumor has been removed surgically, to prevent cancer from recurring.
Aromatase inhibitors are generally considered a better choice than tamoxifen for postmenopausal women. But aromatase inhibitors work only when women have low estrogen levels, which usually rules them out for premenopausal women.
The new study — actually two studies being analyzed together to accumulate nearly 4,700 patients — involved suppressing the functioning of the ovaries so that the younger women could take an aromatase inhibitor.
Five years of an aromatase inhibitor in addition to ovarian suppression proved superior to five years of tamoxifen in addition to ovarian suppression. After five years, 91.1 percent of those who received the aromatase inhibitor, exemestane, were free of cancer, compared with 87.3 percent of those who received tamoxifen with ovarian suppression. (In the United States, tamoxifen is typically used without ovarian suppression.)
Some experts said they were a bit skeptical that the results would change practice, noting that so far there was no difference between the groups in how long the women lived. And side effects must be evaluated, they said. Those include both the joint pain caused by aromatase inhibitors as well as the hot flashes and bone loss that could come from putting women into early menopause so they could use the aromatase inhibitor.
Ovarian suppression is typically accomplished using drugs like goserelin. Another study presented here on Friday showed that goserelin could help preserve fertility in young breast cancer patients.
Exemestane is sold under the brand name Aromasin by Pfizer, though generic versions are commonly used.
(NYTimes)
