From Medical Oncology/Solid Tumor Oncology and the Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, and Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Harold J. Burstein, MD, PhD, Medical Oncology/Solid Tumor Oncology and the Breast Oncology Program, Dana-Farber Cancer Institute, 44 Binney Street, Mayer 2, Boston, MA 02115; e-mail: hburstein{at}partners.org
Overview: Despite large, well-conducted clinical trials examining tamoxifen and aromatase inhibitors as adjuvant endocrine therapy in postmenopausal breast cancer, significant questions persist regarding the optimal use, timing and duration of treatment, and the best strategy for particular subsets of patients. Because clinical trials cannot address every conceivable treatment option or consider each clinical subset, we have explored the use of decision analyses to guide clinical recommendations and generate hypotheses about optimal treatment strategies. We have examined questions, such as the optimal sequencing of treatment with aromatase inhibitors and tamoxifen, and whether subgroups defined by tumor or patient factors may warrant consideration of different treatment options. These models can be valuable for identifying key clinical questions, generating hypotheses worthy of evaluation in prospective trials, and, in certain instances, assisting in decision-making for treatments with patients.
