{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:17:00Z","timestamp":1791051420768,"version":"4.1.0"},"reference-count":28,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2013,4,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In patients with hormone-dependent postmenopausal breast cancer, standard adjuvant therapy involves 5 years of the nonsteroidal aromatase inhibitors anastrozole and letrozole. The steroidal inhibitor exemestane is partially non\u2013cross-resistant with nonsteroidal aromatase inhibitors and is a mild androgen and could prove superior to anastrozole regarding efficacy and toxicity, specifically with less bone loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We designed an open-label, randomized, phase III trial of 5 years of exemestane versus anastrozole with a two-sided test of superiority to detect a 2.4% improvement with exemestane in 5-year event-free survival (EFS). Secondary objectives included assessment of overall survival, distant disease\u2013free survival, incidence of contralateral new primary breast cancer, and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the study, 7,576 women (median age, 64.1 years) were enrolled. At median follow-up of 4.1 years, 4-year EFS was 91% for exemestane and 91.2% for anastrozole (stratified hazard ratio, 1.02; 95% CI, 0.87 to 1.18; P = .85). Overall, distant disease\u2013free survival and disease-specific survival were also similar. In all, 31.6% of patients discontinued treatment as a result of adverse effects, concomitant disease, or study refusal. Osteoporosis\/osteopenia, hypertriglyceridemia, vaginal bleeding, and hypercholesterolemia were less frequent on exemestane, whereas mild liver function abnormalities and rare episodes of atrial fibrillation were less frequent on anastrozole. Vasomotor and musculoskeletal symptoms were similar between arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This first comparison of steroidal and nonsteroidal classes of aromatase inhibitors showed neither to be superior in terms of breast cancer outcomes as 5-year initial adjuvant therapy for postmenopausal breast cancer by two-way test. Less toxicity on bone is compatible with one hypothesis behind MA.27 but requires confirmation. Exemestane should be considered another option as up-front adjuvant therapy for postmenopausal hormone receptor\u2013positive breast cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2012.44.7805","type":"journal-article","created":{"date-parts":[[2013,1,28]],"date-time":"2013-01-28T21:38:42Z","timestamp":1359409122000},"page":"1398-1404","source":"Crossref","is-referenced-by-count":220,"title":["Exemestane Versus Anastrozole in Postmenopausal Women With Early Breast Cancer: NCIC CTG MA.27\u2014A Randomized Controlled Phase III Trial"],"prefix":"10.1200","volume":"31","author":[{"given":"Paul E.","family":"Goss","sequence":"first","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; David B. Johnson, Cancer Center of Kansas, Wichita, KS; Vered Stearns, The Sidney Kimmel Comprehensive Cancer Center at..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Ingle","sequence":"additional","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; David B. Johnson, Cancer Center of Kansas, Wichita, KS; Vered Stearns, The Sidney Kimmel Comprehensive Cancer Center at..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen I.","family":"Pritchard","sequence":"additional","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; David B. Johnson, Cancer Center of Kansas, Wichita, KS; Vered Stearns, The Sidney Kimmel Comprehensive Cancer Center at..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; David B. Johnson, Cancer Center of Kansas, Wichita, KS; Vered Stearns, The Sidney Kimmel Comprehensive Cancer Center at..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George W.","family":"Sledge","sequence":"additional","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. 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Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. Thomas Budd, Cleveland Clinic, Cleveland, OH; David B. Johnson, Cancer Center of Kansas, Wichita, KS; Vered Stearns, The Sidney Kimmel Comprehensive Cancer Center at..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafat H.","family":"Ansari","sequence":"additional","affiliation":[{"name":"Paul E. Goss and Pedro E.R. Liedke, Massachusetts General Hospital, Boston, MA; James N. Ingle, Mayo Clinic, Rochester, MN; Matthew J. Ellis, Siteman Cancer Center, Washington University, St Louis, MO; George W. Sledge, Indiana University Health, Indianapolis; Rafat H. Ansari, Northern Indiana Cancer Research Consortium, South Bend, IN; G. 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