A 58-year-old woman completes 5 years of tamoxifen for ER+ breast cancer and remains postmenopausal. The MA.17 and ATLAS trials support which subsequent strategy to further reduce late recurrence risk?

• A Restart tamoxifen for another 5 years (total 10 years per ATLAS)
• B No further endocrine therapy is required after 5 years
• C Switch to aromatase inhibitor (letrozole) for an additional 5 years ✓
• D Begin CDK4/6 inhibitor monotherapy for 2 years

Explanation

The MA.17 trial showed that extending therapy with letrozole (an aromatase inhibitor) after 5 years of tamoxifen significantly improves disease-free survival in postmenopausal women. The ATLAS trial supports extending tamoxifen to 10 years in premenopausal women, not as a post-tamoxifen switch to AI. For a postmenopausal patient, switching to an AI after tamoxifen (sequential endocrine therapy) is the preferred strategy to reduce late distant recurrence.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.