Exemestane Versus Anastrozole in Postmenopausal Women With Early Breast Cancer: NCIC CTG MA.27—A Randomized Controlled Phase III Trial

PURPOSE 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-cross-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. PATIENTS AND METHODS 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-free survival, incidence of contralateral new primary breast cancer, and safety. RESULTS 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-free 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. CONCLUSION 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-positive breast cancer.

Schwarmdynamik und soziales Miteinander. Zur 'improvisierten Choreographie' You've Changed von Thomas Hauert und der Kompanie ZOO

Der Aufsatz beschäftigt sich mit der 'improvisierten Choreographie' You've Changed des Schweizer Choreographen Thomas Hauert und seiner in Brüssel angesiedelten Kompanie ZOO. Mittels der Denkfigur des Schwarms werden die Funktions- und Organisationsprinzipien der schwärmenden Konstellationen, welche die Tanzenden immer wieder bilden, beschrieben und analysiert. Zusätzlich werden die kinästhetischen Übertragungsprozesse erläutert, die sich in dieser Live-Improvisation zwischen den Tanzenden ereignen. Mittels Überlegungen, die der französische Philosoph Jean-Luc Nancy in seiner Schrift singulär plural sein entwickelt hat, wird anschließend diskutiert, wie in dieser 'improvisierten Choerographie' das gemeinsame Sein beständig ausgehandelt wird, wobei eine heterogene und zugleich integrierte Gemeinschaft entsteht.

"Die Schweiz sollte eine aktivere Rolle spielen" (Interview mit Thomas Cottier von Andreas Valda)

Thomas Cottier, Experte für Handelsrecht, erklärt, warum die Pharmaindustrie beim Freihandelsabkommen mit Indien zu viel verlangt. Und warum die Schweiz bei internationalen Handelskonflikten mehr unternehmen müsste.