Aromatase inhibitors as adjuvant therapy for breast cancer

We have read with interest the article by Seruga and Tannock,1 who critically analyzed the role of aromatase inhibitors as up-front drugs in the adjuvant treatment of postmenopausal hormone receptor–positive breast cancer. Although we basically agree with the line of reasoning of the two respected authors, we feel that some of their conclusions need to be taken with caution. The five most influential trials comparing 5 years of tamoxifen with aromatase inhibitors either up front or administered sequentially after tamoxifen (early switch) confirm that aromatase inhibitors can control cancer regrowth after surgery better than tamoxifen does.2–6 At the present time, however, this superiority has not yet translated into convincing survival benefits. A significant survival advantage is in fact confirmed only in clinical trials using the early switch strategy.7 According to the authors' introductory statements, this would call for adoption of aromatase inhibitors after 2 to 3 years of tamoxifen as a standard of care, an issue that does not emerge clearly from the article. .......................