A 55-year-old postmenopausal woman completed 5 years of adjuvant tamoxifen for ER+ breast cancer. She now presents for discussion of extended adjuvant therapy. The MA.17 trial supports the use of which agent as extended adjuvant therapy beyond 5 years of tamoxifen?

• A Oophorectomy followed by further tamoxifen
• B Fulvestrant
• C Everolimus plus exemestane
• D Letrozole (aromatase inhibitor) ✓

Explanation

The MA.17 (NCIC CTG MA.17) trial demonstrated that letrozole given after 5 years of tamoxifen significantly improved disease-free survival in postmenopausal women with ER+ breast cancer. This established the paradigm of sequential aromatase inhibitor therapy after tamoxifen. Fulvestrant is used in metastatic/advanced settings. Everolimus is used for mTOR pathway resistance in advanced disease. Extended tamoxifen alone is an option but not the MA.17 finding.

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.