The third generation of specific AIs have made a very exciting contribution to the management of hormone responsive breast cancer. We can now state with confidence that their role in advanced breast cancer has overtaken that of tamoxifen, which should be relegated to a second-line treatment. Indeed, as a recent publication confirmed that first-line anastrozole followed by tamoxifen is an effective treatment sequence, this sequence may be considered the best choice for treating patients with hormone receptor-positive ABC . As far as the primary disease is concerned, the ATAC data certainly suggest that there is an alternative to tamoxifen in selected postmenopausal women with hormone receptor-positive disease. With more mature follow-up the study might even show that after a passage of nearly 20 years tamoxifen has lost its lead position in the adjuvant stakes as well.
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