Which aromatase inhibitors provide survival benefits?

Only third-generation aromatase inhibitors (AIs) and inactivators-not earlier agents-significantly increase survival over standard hormonal treatments in women with advanced breast cancer, according to the findings of a meta-analysis of randomized, controlled trials.

Davide Mauri, MD, and colleagues included 25 comparisons involving 8,504 patients and found that only the third-generation agents (vorozole, letrozole, examestane, and anastrazole) provided statistically significant survival benefits over standard hormonal treatment (relative hazard = 0.87; 95% CI; 0.82–0.93; P<0.001). First-generation aminoglutethimide and second-generation formestane and fadrozole did not.

The findings indicate that third-generation AIs and inactivators should be used as first-line treatment for advanced disease instead of tamoxifen and certainly used before progestogens.