Anyone hear that exemestane not ideal tx for high risk ILC?

This is from another member, but I couldn't get into the link (although I linked it here). Really kind of bummed me out (#1) since I can't tolerate Arimidex or any others hormonal txs.

Claire

Jun 15, 2016 01:10PM Molly50 wrote:

This is an excerpt from an article called Ten Practice Changes I will make after ASCO 2016: I am posting just the part important to BC and AI's:

1. I will not use exemestane as adjuvant treatment for invasive lobular breast cancer in favor of one of the two nonsteroidal AIs, anastrozole or letrozole (Abstract521). There are increasing data that exemestane is less effective in patients with this histology, which was confirmed by this review of the MA.27 study by Strasser-Weippl et al. Patients with invasive lobular carcinoma had improved overall survival when treated with anastrozole as opposed to exemestane (HR, 1.8; P = .55), consistent with the findings in the BIG 1-98 trial.
2. I will be using more AC/T and less TC in patients with high-risk early breast cancer, based on the ABC analysis of three randomized trials presented by Blum et al (Abstract 1000). In this initial report, the non-anthracycline regimen did NOT demonstrate noninferiority to the anthracycline regimens. TC may be noninferior for ER-positive patients, however, but for receptor-negative patients, I will use anthracyclines in most cases.
3. I will recommend the continuation of aromatase inhibitor (AI) therapy for at least an additional 5 years in high-risk postmenopausal women with early-stage breast cancer. Many of these women have been reluctant to stop their AI at 5 years; I have generally made recommendations case by case, but mentioned that we will have data to help guide our decisions, once we had the results from the MA.17R and B42 studies. The initial results from MA17.R were presented at the Plenary Session (Abstract LBA1) by Dr. Goss. In patients treated with 5 years of AI, as initial therapy or preceded by up to 5 years of tamoxifen, extended AI treatment to 10 years (as opposed to placebo) significantly improved disease-free survival. The gains were modest, and there was an increased risk of osteoporosis; so, I don't plan on this approach in all of these women, but I will have the discussion, considering the risks and benefits, and probably recommend continuation in women at high risk of late recurrence. Data presented in Abstract 505 by Pan et al was an analysis of predictive factors for late recurrences in ER-positive patients (over 46,000 British women followed for up to 14 years), and its findings will help in advising our patients.