Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial

• Published in: The Lancet (British edition) 2020-01, Vol.395 (10218), p.117-122
• Main Authors: Cuzick, Jack, Sestak, Ivana, Forbes, John F, Dowsett, Mitch, Cawthorn, Simon, Mansel, Robert E, Loibl, Sibylle, Bonanni, Bernardo, Evans, D Gareth, Howell, Anthony
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Aged; Analysis; Anastrozole; Anastrozole - adverse effects; Anastrozole - therapeutic use; Aromatase; Aromatase Inhibitors - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - mortality; Breast Neoplasms - prevention & control; Cancer; Carcinoma, Ductal; Carcinoma, Ductal, Breast - drug therapy; Carcinoma, Ductal, Breast - pathology; Carcinoma, Intraductal, Noninfiltrating - drug therapy; Carcinoma, Intraductal, Noninfiltrating - pathology; Cardiovascular disease; Cardiovascular diseases; Clinical trials; Data collection; Diagnosis; Disease prevention; Female; Follow-Up Studies; Fractures; Health risk assessment; Hormone replacement therapy; Humans; Incidence; Invasiveness; Mammography; Medical research; Melanoma; Middle Aged; Mortality; Oncology, Experimental; Placebos; Post-menopause; Postmenopausal women; Prevention; Randomization; Reduction; Side effects; Skin cancer; Task forces; Treatment Outcome; Tumors; United Kingdom - epidemiology; Womens health
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(19)32955-1

Two large clinical trials have shown a reduced rate of breast cancer development in high-risk women in the initial 5 years of follow-up after use of aromatase inhibitors (MAP.3 and International Breast Cancer Intervention Study II [IBIS-II]). Here, we report blinded long-term follow-up results for the IBIS-II trial, which compared anastrozole with placebo, with the objective of determining the efficacy of anastrozole for preventing breast cancer (both invasive and ductal carcinoma in situ) in the post-treatment period. IBIS-II is an international, randomised, double-blind, placebo-controlled trial. Postmenopausal women at increased risk of developing breast cancer were recruited and were randomly assigned (1:1) to either anastrozole (1 mg per day, oral) or matching placebo daily for 5 years. After treatment completion, women were followed on a yearly basis to collect data on breast cancer incidence, death, other cancers, and major adverse events (cardiovascular events and fractures). The primary outcome was all breast cancer. 3864 women were recruited between Feb 2, 2003, and Jan 31, 2012. 1920 women were randomly assigned to 5 years anastrozole and 1944 to placebo. After a median follow-up of 131 months (IQR 105–156), a 49% reduction in breast cancer was observed for anastrozole (85 vs 165 cases, hazard ratio [HR] 0·51, 95% CI 0·39–0·66, p