CoChat
Sign Up
Cited by 1,674Breast Cancer Treatment StudiesEstrogen and related hormone effectsEndometrial and Cervical Cancer Treatments

The DOI matches its Crossref record; 26 of the 27 references it cites were found in a registry or an index.

Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial

Cuzick, Jack, Sestak, Ivana, Baum, Michael, Buzdar, Aman, Howell, Anthony, Dowsett, Mitch, Forbes, John F·2010·The Lancet Oncology
DOI 10.1016/s1470-2045(10)70257-6
Open this paper in CoChat — free account

Abstract

Background The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial was designed to compare the efficacy and safety of anastrozole (1 mg) with tamoxifen (20 mg), both given orally every day for 5 years, as adjuvant treatment for postmenopausal women with early-stage breast cancer. In this analysis, we assess the long-term outcomes after a median follow-up of 120 months.Methods We used a proportional hazards model to assess the primary endpoint of disease-free survival, and the secondary endpoints of time to recurrence, time to distant recurrence, incidence of new contralateral breast cancer, overall survival, and death with or without recurrence in all randomised patients (anastrozole n=3125, tamoxifen n=3116) and hormone-receptor-positive patients (anastrozole n=2618, tamoxifen n=2598). After treatment completion, we continued to collect data on fractures and serious adverse events in a masked fashion (safety population: anastrozole n=3092, tamoxifen n=3094). This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN18233230.Findings Patients were followed up for a median of 120 months (range 0-145); there were 24,522 woman-years of follow-up in the anastrozole group and 23,950 woman-years in the tamoxifen group. In the full study population, there were significant improvements in the anastrozole group compared with the tamoxifen group for disease-free survival (hazard ratio [HR] 0·91, 95% CI 0·83-0·99; p=0·04), time to recurrence (0·84, 0·75-0·93; p=0·001), and time to distant recurrence (0·87, 0·77-0·99; p=0·03). For hormone-receptor-positive patients, the results were also significantly in favour of the anastrozole group for disease-free survival (HR 0·86, 95% CI 0·78-0·95; p=0·003), time to recurrence (0·79, 0·70-0·89; p=0·0002), and time to distant recurrence (0·85, 0·73-0·98; p=0·02). In hormone-receptor-positive patients, absolute differences in time to recurrence between anastrozole and tamoxifen increased over time (2·7% at 5 years and 4·3% at 10 years) and recurrence rates remained significantly lower on anastrozole than tamoxifen after treatment completion (HR 0·81, 95% CI 0·67-0·98; p=0·03), although the carryover benefit was smaller after 8 years. There was weak evidence of fewer deaths after recurrence with anastrozole compared with tamoxifen treatment in the hormone-receptor-positive subgroup (HR 0·87, 95% CI 0·74-1·02; p=0·09), but there was little difference in overall mortality (0·95, 95% CI 0·84-1·06; p=0·4). Fractures were more frequent during active treatment in patients receiving anastrozole than those receiving tamoxifen (451 vs 351; OR 1·33, 95% CI 1·15-1·55; p<0·0001), but were similar in the post-treatment follow-up period (110 vs 112; OR 0·98, 95% CI 0·74-1·30; p=0·9). Treatment-related serious adverse events were less common in the anastrozole group than the tamoxifen group (223 anastrozole vs 369 tamoxifen; OR 0·57, 95% CI 0·48-0·69; p<0·0001), but were similar after treatment completion (66 vs 78; OR 0·84, 95% CI 0·60-1·19; p=0·3). No differences in non-breast cancer causes of death were apparent and the incidence of other cancers was similar between groups (425 vs 431) and continue to be higher with anastrozole for colorectal (66 vs 44) and lung cancer (51 vs 34), and lower for endometrial cancer (six vs 24), melanoma (eight vs 19), and ovarian cancer (17 vs 28). No new safety concerns were reported.Interpretation These data confirm the long-term superior efficacy and safety of anastrozole over tamoxifen as initial adjuvant therapy for postmenopausal women with hormone-sensitive early breast cancer.

Overview

Integrity signals

Registry

Crossref · 10.1016/s1470-2045(10)70257-6

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Citations

Cites

Cited by

Sorted by citations

See all 1,674

Related

See all

Metadata

Authors
Cuzick, J., Sestak, I., Baum, M., Buzdar, A., Howell, A., Dowsett, M., & Forbes, J. F.
Affiliations
  • University of London (GB)
  • Cancer Research UK (GB)
  • The University of Texas MD Anderson Cancer Center (US)
  • Royal Marsden Hospital (GB)
  • University of Newcastle Australia (AU)
Corresponding author
Cuzick, Jack
ORCID
Venue
The Lancet Oncology
Publisher
Elsevier BV
Published
2010-12
Volume
11
Issue
12
Pages
1135-1141
ISSN
1470-2045 (ISSN-L)
DOI
10.1016/s1470-2045(10)70257-6
OpenAlex
W2112780046
Cited by
1,674
References
27
Citations by year
2026: 21 · 2025: 35 · 2024: 50 · 2023: 54 · 2022: 63 · 2021: 64 · 2020: 85 · 2019: 66 · 2018: 85 · 2017: 98 · 2016: 101 · 2015: 116 · 2014: 125 · 2013: 148 · 2012: 121
FWCI
51.63
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Lancet Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Funders
AstraZeneca
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
  • Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Keywords
anastrozole, tamoxifen, adjuvant endocrine therapy, early breast cancer, postmenopausal women, disease-free survival, time to recurrence, distant recurrence, hormone receptor-positive breast cancer, contralateral breast cancer, overall survival, fracture risk, long-term outcomes, ATAC trial, aromatase inhibitors, selective estrogen receptor modulators, breast cancer recurrence
MeSH terms
Anastrozole, Administration, Oral, Breast Neoplasms, Female, Follow-Up Studies, Humans, Neoplasm Staging, Nitriles, Tamoxifen, Triazoles, Treatment Outcome, Chemotherapy, Adjuvant, Postmenopause, Kaplan-Meier Estimate

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review