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Aromatase inhibitors may be better than Tamoxifen In Er+, Her-2 + breast cancer in post-menopausal breast cancer

A recent multi-centre trial reported in the Journal of Clinical Oncology (Vol 19: 3808-3816) reported a superior response rate in post menopausal breast cancer patients who were treated with the aromatase inhibitor: letrozole, rather than tamoxifen. This is an intriguing finding of differential sensitivity to one method of endocrine therapy over another in breast cancer. The authors speculate that a molecular mechanism for their findings is that, by removing the source of oestrogens to which these tumours are highly dependent, the aromatase inhibitor is able to overcome the HER-1/2 resistance pathway to which tamoxifen is susceptible. Whilst the accompnying editorial in the Journal is rightly cautious in accepting the findings without other confirmation, nevertheless it points out that aromatase are fast becoming an attractive first line endocrine therapy in this disease.