Systematic Review Of Aromataseinhibitors In First-Line Treatment For Hormone Sensitive Early Stage Breast Cancer: A Meta-Analysis

Purpose:Adjuvant endocrine therapy of early stage breast cancer in postmenopausal women with hormone receptor-positive include Letrozole, Tamoxifen, Exemestane, Anastrozole, and Toremifene. Since the optimum regimen remains inconclusive, we targeted to compare overall survival(OS) for these treatments in terms after tumor resection with a systematic review and Fixed-effects Bayesian network meta-analysis.Methods:Searched PubMed, ClinicalTrials.gov, and EMBASE database were systematically reviewed of abstract for randomized-controlled trials assessing the safety and efficacy of Letrozole(2.5mg), Tamoxifen(20mg), Exemestane(25mg), Anastrozle(lmg), and Toremifene(60mg) for first-line treatment of post-menopausal women with hormone receptor-positive, patient who have not received prior therapy for early stage breast cancer. Outcome measures overall survival, we evaluated relative hazard ratios for death of different therapies by combination hazard ratios for death of included trials.Results:A total of four studies including 19517 patients met our search inclusion criteria and were estimated. Compared with tamoxifen, the hazard ratio for death Were 0.87(95%CI:0.76-0.99)for letrozole,0.87.(95%CI:0.75-1)for exemestane,0.98(95%CI:0.63-1.46) for toremifene,0.95(95%CI:0.85-1.05) for anastrozole. The results show that letrozole or exemestane is the best efficacy.Conclusion:This meta-analysis indicate that adjuvant endocrine therapy withletrozole or exemestane is the optimum adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive early stage breast cancer. In addition, Toremifene is more effective than Anastrozole or Tamoxifen for early stage breast cancer.