Skip to main content
SpringerLink
Log in

Letrozole

A Pharmacoeconomic Review of its Use in Postmenopausal Women with Breast Cancer

  • Adis Pharmacoeconomic Drug Evaluation
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Letrozole (Femara®), an aromatase inhibitor that blocks estrogen synthesis by inhibiting the final step of the estrogen biosynthetic pathway, is approved for use in a wide range of breast cancer settings. Randomised clinical trials in postmenopausal women with hormone-responsive early-stage breast cancer have demonstrated that, as adjuvant therapy, letrozole has greater efficacy than tamoxifen. It is also more effective than placebo as extended adjuvant therapy after completion of tamoxifen therapy in these patients. In women with hormone-responsive advanced breast cancer, letrozole is superior to tamoxifen in prolonging the time to disease progression and time to treatment failure in a first-line setting, and is at least as effective as anastrozole and more effective than megestrol for some endpoints (in one of two trials) in a second-line setting. Letrozole is generally well tolerated, and in a health-related quality-of-life analysis from a large clinical trial, patient well-being with letrozole as extended adjuvant therapy did not differ from that with placebo.

Modelled analyses from the UK and the US suggest that, in postmenopausal women with hormone-receptor-positive early-stage breast cancer, letrozole is likely to be a cost-effective alternative to tamoxifen as adjuvant therapy; moreover, using letrozole as extended adjuvant therapy after tamoxifen, rather than no further treatment, is also a cost-effective treatment strategy. Sensitivity analyses have shown these results to be robust. In terms of direct healthcare costs, pharmacoeconomic models suggest that letrozole is a cost-effective alternative to tamoxifen as first-line therapy in postmenopausal women with hormone-responsive advanced breast cancer from the perspectives of the UK NHS, the Canadian and Italian public healthcare systems and the Japanese national health insurance system. Incremental costs per QALY or progression-free year gained over tamoxifen were well within the recommended limits for acceptability of new agents that are more effective and more expensive than existing therapies in the UK, Japan and Canada. Modelled analyses from the UK and Canada have also suggested that letrozole is cost effective as second-line therapy for advanced breast cancer in postmenopausal women who have disease progression following anti-estrogen therapy.

In conclusion, letrozole is an effective and well tolerated treatment for postmenopausal women with early-stage or advanced hormone-responsive breast cancer. Pharmacoeconomic analyses from UK and North American perspectives support the use of letrozole in hormone-responsive early-stage breast cancer in both the adjuvant and extended adjuvant settings. In addition, other modelled analyses conducted in a variety of healthcare systems across different countries consistently suggest that letrozole is cost effective in advanced treatment settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V

Similar content being viewed by others

Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Travis RC, Key TJ. Oestrogen exposure and breast cancer risk. Breast Cancer Res 2003; 5: 239–247

    Article  PubMed  CAS  Google Scholar 

  2. Miller WR. Biology of aromatase inhibitors: pharmacology/endocrinology within the breast. Endocr Relat Cancer 1999; 6: 187–195

    Article  PubMed  CAS  Google Scholar 

  3. SzyrrrakJ, Milewicz A, Thijssen JL, et al. Concentration of sex steroids in adipose tissue after menopause. Steroids 1998; 63: 319–321

    Article  Google Scholar 

  4. National Comprehensive Cancer Network. Clinical practice guidelines in oncology: v.2.2006. Breast Cancer version 2.2006 [online]. Available from URL: http://www.nccn.org [Accessed 2005 Nov 28]

  5. National Institute for Clinical Excellence. Guidance on cancer services: improving outcomes in breast cancer. Manual update [online]. Available from URL: http://www.nice.org.uk [Accessed 2005 Oct 17]

  6. Jaiyesimi IA, Buzdar AU, Decker DA, et al. Use of tamoxifen for breast cancer: twenty-eight years later. J Clin Oncol 1995; 13: 513–529

    PubMed  CAS  Google Scholar 

  7. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365 (9472): 1687–1717

    Article  Google Scholar 

  8. Buzdar AU. Pharmacology and pharmacokinetics of the newer generation aromatase inhibitors. Clin Cancer Res 2003; 9 Suppl.: 468S–472S

    CAS  Google Scholar 

  9. Choueiri TK, Alemany CA, Abou-Jawde RM, et al. Role of aromatase inhibitors in the treatment of breast cancer. Clin Ther 2004; 26 (8): 1199–1214

    Article  PubMed  CAS  Google Scholar 

  10. Cuzick J, Powles T, Veronesi U, et al. Overview of the main outcomes in breast-cancer prevention trials. Lancet 2003; 361: 296–300

    Article  PubMed  CAS  Google Scholar 

  11. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial. J Natl Cancer Inst 2001; 93 (9): 684–690

    Article  PubMed  CAS  Google Scholar 

  12. Karnon J. Aromatase inhibitors in breast cancer: a review of cost considerations and cost effectiveness. Pharmacoeconomics 2006; 24 (3): 215–232

    Article  PubMed  CAS  Google Scholar 

  13. Femara® (letrozole tablets) 2.5mg tablets. US prescribing information. East Hanover (NJ): Novartis Pharmaceuticals Corporation [online]. Available from URL: http://www.femara.com [Accessed 2006 Mar 6]

  14. Novartis Pharmaceuticals UK Ltd. Femara SPC from the eMC [online]. Available from URL: http://emc.medicines.org.uk [Accessed 2006 Mar 6]

  15. Femara® (letrozole). European summary of product characteristics. Novartis Oncology [online]. Available from URL: http://www.femarainfo.com/european/indexjsp [Accessed 2006 Mar 6]

  16. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics 2002. CA Cancer J Clin 2005; 55: 74–108

    Article  PubMed  Google Scholar 

  17. Ferlay J, Bray F, Pisani P, et al. GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide. IARC CancerBase No.5. version 2.0. Lyon: IARC Press, 2004 [online]. Available from URL: http://www-depjarc.fr/ [Accessed 2006 Mar 1]

    Google Scholar 

  18. Office for National Statistics. Breast cancer: incidence rate rises while death rate falls [online]. Available from URL: http://www.statistics.gov.uk/cci/nugget.asp [Accessed 2005 Aug 16]

  19. Tyczynski JE, Bray F, Parkin DM. European Network of Cancer Registriesllnternational Agency for Research on Cancer ENCR cancer fact sheets vol. 2 December 2002. Breast cancer in Europe [online]. Available from URL: http://www.encr.com.fr [Accessed 2005 Aug 15]

  20. American Cancer Society. Cancer facts and figures 2006. Atlanta (GA): American Cancer Society, 2006

    Google Scholar 

  21. Radice D, Redaelli A. Breast cancer management: quality-of-life and cost considerations. Pharmacoeconomics 2003; 21 (6): 383–396

    Article  PubMed  Google Scholar 

  22. Rao S, Kubisiak J, Gilden D. Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 2004 Jan; 83 (1), 25–32

    Article  PubMed  CAS  Google Scholar 

  23. Berkowitz N, Gupta S, Silberman G. Estimates of the lifetime direct costs of treatment for metastatic breast cancer. Value Health 2000 Jan; 3 (1): 23–30

    Article  PubMed  CAS  Google Scholar 

  24. Will BP, Berthelot J-M, Le Petit C, et al. Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 2000; 36: 724–735

    Article  PubMed  CAS  Google Scholar 

  25. Remák E, Brazil L. Cost of managing women presenting with stage IV breast cancer in the United Kingdom. Br J Cancer 2004 Ju15; 91 (1): 77–83

    Article  PubMed  Google Scholar 

  26. Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone-receptor-positive breast cancer: status report 2004. J Clin Oncol 2004; 23 (3): 619–629

    Article  PubMed  Google Scholar 

  27. Goldhirsch A, Glick JH, Gelber RD, et al. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 2005; 16 (10): 1569–1583

    Article  PubMed  CAS  Google Scholar 

  28. Baum M. Current status of aromatase inhibitors in the management of breast cancer and critique of the NCIC MA-17 trial. Cancer Control 2004; 11 (4): 217–221

    PubMed  Google Scholar 

  29. Thürlimann B, Keshaviah A, Coates AS, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. The Breast International Group (BIG) 1-98 Collaborative Group. New Engl J Med 2005; 353 (26): 2747–2757

    Article  PubMed  Google Scholar 

  30. Goss PE, Ingle JN, Martino S, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 2005; 97 (17): 1262–1271

    Article  PubMed  CAS  Google Scholar 

  31. Mouridsen H, Gershanovich M, Sun Y, et al. Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a phase III study of the International Letrozole Breast Cancer Group [published erratum appears in J Clin Oncol 2001; 19 (13): 3302]. J Clin Oncol 2001; 19 (10): 2596–2606

    PubMed  CAS  Google Scholar 

  32. Dormernowsky P, Smith I, Falkson G, et al. Letrozole, a new oral aromatase inhibitor for advanced breast cancer: double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol. J Clin Oncol 1998; 16: 453–461

    Google Scholar 

  33. Rose C, Vtoraya O, Pluzanska A, et al. An open randomised trial of second-line endocrine therapy in advanced breast cancer: comparison of the aromatase inhibitors letrozole and anastrozole. Eur J Cancer 2003; 39: 2318–2327

    Article  PubMed  CAS  Google Scholar 

  34. Buzdar A, Douma J, Davidson N, et al. Phase III, multicenter, double-blind, randomized study of letrozole, an aromatase inhibitor, for advanced breast cancer versus megestrol. J Clin Oncol 2001; 19 (14): 3357–3366

    PubMed  CAS  Google Scholar 

  35. Scott L, Kearn SJ. Letrozole in post-menopausal hormone-responsive, early-stage breast cancer. Drugs 2006; 66 (3): 353–362

    Article  PubMed  CAS  Google Scholar 

  36. Keating GM, Jarvis B. Letrozole: an updated review of its use in postmenopausal women with advanced breast cancer. Am J Cancer 2002; 1 (5): 351–371

    Article  CAS  Google Scholar 

  37. Simpson D, Curran MP, Perry CM. Letrozole: a review of its usein postmenopausal women with breast cancer. Drugs 2004; 64 (11): 1213–1230

    Article  PubMed  CAS  Google Scholar 

  38. Whelan TJ, Goss PE, Ingle JN, et al. Assessment of quality of life in MA.17: a randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. J Clin Oncol 2005 Oct; 23 (28): 6931–6940

    Article  PubMed  CAS  Google Scholar 

  39. Abetz L, Barghout V, de la Loge C, et al. No differences in quality of life for letrozole relative to placebo in postmenopausal women with early breast cancer regardless of age: results from the MA.17 study [abstract no. 342]. Eur J Cancer Suppl 2005; 3 (2): 96

    Google Scholar 

  40. Irish W, Sherrill B, Cole B, et al. Quality-adjusted survival in a crossover trial of letrozole versus tamoxifen in postmenopausal women with advanced breast cancer. Ann Oncol 2005; 16: 1458–1462

    Article  PubMed  CAS  Google Scholar 

  41. Thomas R. Examining quality of life issues in relation to endocrine therapy for breast cancer. Am J Clin Oncol 2003 Aug; 26 (4 Suppl. 1): S40–S44

    Article  PubMed  Google Scholar 

  42. Viale G, Regan M, Dell’Orto P, et al. Central review of ER, PgR and HER-2 in BIG 1-98 evaluating letrozole vs tamoxifen as adjuvant endocrine therapy for postmenopausal women with receptor-positive breast cancer [abstract no. 44]. 28th Annual San Antonio Breast Cancer Syrrposium; 2005 Dec 8–11; San Antonio (TX)

  43. Goss PE, Ingle JN, Palmer MJ, et al. Updated analysis of NCIC CTG MA.17 (letrozole vs placebo to letrozole vs placebo) post unblinding [abstract no. 16]. Breast Cancer Res Treat 2005; 94 Suppl. 1: 10–11. Plus oral presentation at the 28th Annual San Antonio Breast Cancer Symposium; 2005 Dec 8–11; San Antonio (TX)

    Google Scholar 

  44. Ingle JN, Goss PE, Tu DE. Analysis of duration of letrozole as extended adjuvant therapy as measured by hazard ratios of disease recurrence over time for patients on NCIC CTG MA.17 [abstract no. 17]. Breast Cancer Res Treat 2005; 94 Suppl. 1: 11. Plus oral presentation at the 28th Annual San Antonio Breast Cancer Symposium; 2005 Dec 8–21; San Antonio (TX)

    Article  Google Scholar 

  45. Mouridsen H, Gershanovich M, Sun Y, et al. Phase III study of letrozole versus tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: analysis of survival and update of efficacy from the International Letrozole Breast Cancer Group. J Clin Oncol 2003; 21: 2101–2109

    Article  PubMed  CAS  Google Scholar 

  46. Mann BS, Johnson JR, Kelly R, et al. Letrozole in the extended adjuvant treatment of postmenopausal women with history of early-stage breast cancer who have completed 5 years of adjuvant tamoxifen. Clin Cancer Res 2005; 11 (16): 5671–5677

    Article  PubMed  CAS  Google Scholar 

  47. Karnon J, Delea TE, Barghout V, et al. Cost-effectiveness analysis of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer: the UK perspective [abstract no. 2058 plus poster]. 28th San Antonio Breast Cancer Symposium; 2005 Dec 8–11; San Antonio (TX)

    Google Scholar 

  48. Delea TE, Karnon J, Thomas SK, et al. Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer from a US perspective [abstract no. 2054 plus poster]. 28th Annual San Antonio Breast Cancer Symposium; 2005 Dec 8–11; San Antonio (TX)

    Google Scholar 

  49. Delea TE, Karnon J, Smith RE, et al. Cost-effectiveness of five years of extended adjuvant letrozole in postmenopausal women with early breast cancer who have completed five years of adjuvant tamoxifen [abstract no. 1050]. Breast Cancer Res Treat 2004; 88 Suppl. 1: 58. Plus poster presented at the 27th Annual San Antonio Breast Cancer Symposium; 2004 Dec 8–11; San Antonio (TX)

    Google Scholar 

  50. Karnon J, Delea T, Johnson S, et al. Cost-effectiveness of extended adjuvant letrozole in postmenopausal women after adjuvant tamoxifen therapy: the UK perspective. Pharmacoeconomics 2006; 24 (3): 237–250

    Article  PubMed  CAS  Google Scholar 

  51. El Ouagari K, Talbot W. Letrozole (Femara) is a cost-effective treatment in the extended adjuvant setting in women with early breast cancer: an application to Canada [abstract no. PCN18]. Value Health 2005; 8 (6): A38. Plus poster presented at the 8th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research; 2005 Nov 6–8; Florence

    Google Scholar 

  52. Karnon J, Brown J. Tamoxifen plus chemotherapy versus tamoxifen alone as adjuvant therapies for node-positive postmenopausal women with early breast cancer: a stochastic economic evaluation. The Adjuvant Breast Cancer (ABC) Steering Committee. Pharmacoeconomics 2002; 20 (2): 119–137

    Article  PubMed  CAS  Google Scholar 

  53. Sorensen SV, Brown R, Benedict A, et al. Patient-rated utilities in postmenopausal early breast cancer (EBC): a cross-country comparison [abstract no. QL4]. Value Health 2004; 7 (6): 641–642

    Article  Google Scholar 

  54. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgements. BMJ 2004; 329: 224–227

    Article  PubMed  Google Scholar 

  55. Data on file. Novartis Oncology, 2006

  56. Kanis JA, Brazier JE, Stevenson M, et al. Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 2002; 6 (29): 1–146

    PubMed  CAS  Google Scholar 

  57. de Haes JCJM, de Koning HJ, van Oortmarssen GJ, et al. The impact of a breast cancer screening programme on quality-adjusted life-years. Int J Cancer 1991; 49: 538–544

    Article  PubMed  Google Scholar 

  58. Jonsson B. Changing health environment: the challenge to demonstrate cost-effectiveness of new compounds. Pharmacoeconomics 2004; 22 Suppl. 4: 5–10

    Article  Google Scholar 

  59. Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost-utility assessments in oncology. J Clin Oncol 2000; 18: 3302–3317

    PubMed  CAS  Google Scholar 

  60. Karnon J, Johnston SRD, Jones T, et al. A trial-based cost-effectiveness analysis of letrozole followed by tamoxifen versus tamoxifen followed by letrozole for postmenopausal advanced breast cancer. Ann Oncol 2003; 14 (11): 1629–1633

    Article  PubMed  CAS  Google Scholar 

  61. Karnon J, Jones T. A stochastic economic evaluation of letrozole versus tamoxifen as a first-line hormonal therapy for advanced breast cancer in postmenopausal patients. Pharmacoeconomics 2003; 21 (7): 513–525

    Article  PubMed  CAS  Google Scholar 

  62. Dranitsaris G, Verma S, Trudeau M. Cost utility analysis of first-line hormonal therapy in advanced breast cancer: comparison of two aromatase inhibitors to tamoxifen. Am J Clin Oncol 2003 Jun; 26 (3): 289–296

    PubMed  Google Scholar 

  63. Marchetti M, Caruggi M, Colombo G. Cost utility and budget impact of third-generation aromatase inhibitors for advanced breast cancer: a literature-based model analysis of costs in the Italian National Health Service. Clin Ther 2004; 26 (9): 1546–1561

    Article  PubMed  Google Scholar 

  64. Okubo I, Kondo M, Toi M, et al. Cost-effectiveness ofletrozole versus tamoxifen as first-line hormonal therapy in treating postmenopausal women with advanced breast cancer in Japan. Jpn J Cancer Chemother 2005; 32 (3): 351–363

    Google Scholar 

  65. Delea T, Smith R, Karnon J. Cost-effectiveness of letrozole vs tamoxifen as 1st line hormonal therapy for postmenopausal women with advanced breast cancer: the US perspective [abstract no. 542]. 25th Annual San Antonio Breast Cancer Symposium; 2002 Dec 11–14; San Antonio (TX)

    Google Scholar 

  66. Fricke F-U, Quednau K, Pirk O. A stochastic economic evaluation of letrozole versus tamoxifen as a first-line hormonal therapy for advanced breast cancer in postmenopausal patients in Germany [abstract no. CN1]. Value Health 2002; 5 (6): 443

    Article  Google Scholar 

  67. Bonneterre J, Thürlimann B, Robertson JFR, et al. Anastrozole versus tamoxifen as first-line therapy for advanced cancer in 668 postmenopausal women: results of the tamoxifen or Arimidex randomised group efficacy and tolerability study. J Clin Oncol 2000; 18 (22): 3748–3757

    PubMed  CAS  Google Scholar 

  68. Nabholtz JM, Budzar A, Pollack M, et al. Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group. J Clin Oncol 2000; 18: 3758–3767

    PubMed  CAS  Google Scholar 

  69. Kaufmann M, Bajetta E, Dirix L Y, et al. Exemestane is superior to megestrol after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. The Exemestane Study Group. J Clin Oncol 2000; 18: 1399–1411

    PubMed  CAS  Google Scholar 

  70. Falkson CI, Falkson HC. A randomised study of CGS 16949A (fadrozole) versus tamoxifen in previously untreated postmenopausal patients with metastatic breast cancer. Ann Oncol 1996; 7: 465–469

    Article  PubMed  CAS  Google Scholar 

  71. Thürlimann B, Beretta K, Bacchi M, et al. First-line fadrozole HCI (CGS 16949A) versus tamoxifen in postmenopausal women with advanced breast cancer: prospective randomised trial of the Swiss Group for Clinical Cancer Research SAKK 20/88. Ann Oncol 1996; 7: 471–479

    Article  PubMed  Google Scholar 

  72. Hayes DF, Van Zyl J A, Hacking A, et al. Randomized comparison of tamoxifen and two separate doses of toremifene in postmenopausal patients with metastatic breast cancer. J Clin Oncol 1995; 13: 2556–2566

    PubMed  CAS  Google Scholar 

  73. Stuart NS, Warwick J, Blackledge GR, et al. A randomised phase III cross-over study of tamoxifen versus megestrol in advanced and recurrent breast cancer. Eur J Cancer 1996; 32A: 1888–1892

    Article  PubMed  CAS  Google Scholar 

  74. Milla-Santos A, Milla L, Portello J. Anastrozole versus tamoxifen as first-line therapy in postmenopausal patients with hormone-dependent advanced breast cancer: a prospective, randomized, phase III study. Am J Clin Oncol 2003; 26 (3): 317–322

    PubMed  CAS  Google Scholar 

  75. Dranitsaris G, Leung P, Mather J, et al. Cost-utility analysis of second-line hormonal therapy in advanced breast cancer: a comparison of two aromatase inhibitors to megestrol. Anticancer Drugs 2000 Aug; 11: 591–601

    Article  PubMed  CAS  Google Scholar 

  76. Nuijten M, Meester L, Waibel F, et al. Cost effectiveness of letrozole in the treatment of advanced breast cancer in postmenopausal women in the UK. Pharmacoeconomics 1999; 16 (4): 379–397

    Article  PubMed  CAS  Google Scholar 

  77. Smith TJ, Billner BE. Tamoxifen should be cost-effective in reducing breast cancer risk in high-risk women. J Clin Oncol 2000; 18: 284–286

    PubMed  CAS  Google Scholar 

  78. Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992; 146 (4): 473–481

    PubMed  CAS  Google Scholar 

  79. Nuijten M, McCormick J, Waibel F, et al. Economic evaluation of letrozole in the treatment of advanced breast cancer in postmenopausal women in Canada. Value Health 2000; 3 (1): 31–39

    Article  PubMed  CAS  Google Scholar 

  80. Verma S, Rocchi A. Economic evaluation of antiaromatase agents in the second-line treatment of metastatic breast cancer. Support Care Cancer 2003; 11: 728–734

    Article  PubMed  Google Scholar 

  81. Gershanovich M, Chaudri HA, Campos D, et al. Letrozole, a new aromatase inhibitor: randomised trial comparing 2.5mg daily, O.5 mg daily and aminoglutethimide in postmenopausal women with advanced breast cancer. Ann Oncol 1998; 9: 639–645

    Article  PubMed  CAS  Google Scholar 

  82. Bajetta E, Zilembo N, Dowsett M, et al. Double-blind, randomised, multicentre endocrine trial comparing two letrozole doses, in postmenopausal breast cancer patients. Eur J Cancer 1999; 35 (2): 208–213

    Article  PubMed  CAS  Google Scholar 

  83. Buzdar AU, Jones SE, Vogel CL, et al. A phase III trial comparing anastrozole (1 and 10 milligrams), a potent and selective aromatase inhibitor, with megestrol in postmenopausal women with advanced breast carcinoma. The Arimidex Study Group. Cancer 1997; 79: 730–739

    Article  PubMed  CAS  Google Scholar 

  84. Jonat W, Howell A, Blomqvist C, et al. A randomised trial comparing two doses of the new selective aromatase inhibitor anastrozole (Arimidex) with megestrol in postmenopausal patients with advanced breast cancer. Eur J Cancer 1996; 32A (3): 404–412

    Article  PubMed  CAS  Google Scholar 

  85. Buzdar AU, Jonat W, Howell A, et al. Anastrozole versus megestrol in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Arimidex Study Group [published erratum appears in Cancer 1999; 85 (4): 1010]. Cancer 1998; 83 (6): 1142–1152

    Article  PubMed  CAS  Google Scholar 

  86. Karnon J, Johnston SRD, Delea T, et al. Letrozole is costeffective versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: BIG 1-98 [abstract no. 341]. Eur J Cancer Supplements 2005; 3 (2): 96. Plus poster presented at ECCO 13 — the European Cancer Conference; 2005 Oct 30–Nov 3; Paris

    Google Scholar 

  87. Novartis Oncology. UK leads Europe and US in milestone postop breast cancer treatment decision [media release]. Available from URL: http://www.femara.com [Accessed 2005 Oct 17]

Download references

Author information

Authors and Affiliations

  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 1311, New Zealand

    Christopher Dunn & Susan J. Keam

Authors
  1. Christopher Dunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan J. Keam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan J. Keam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dunn, C., Keam, S.J. Letrozole. Pharmacoeconomics 24, 495–517 (2006). https://doi.org/10.2165/00019053-200624050-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200624050-00007

Keywords

Search

Navigation