Aspirin vs placebo as adjuvant therapy for breast cancer. The Alliance A011502 randomized trial.

Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF et al.
N Engl J Med 2021; 385: 2336-2347

The study included 5083 women with hormone receptor positive, HER 2 negative breast cancer with 1-3 positive axillary nodes and a recurrence score above 25. They all received endocrine therapy, and were randomized to additional chemotherapy. Five year overall survival rates were not improved with chemotherapy: 91.3 versus 91.9 percent, but disease-free survival was better in premenopausal women.

Comment: A large and complex trial that helps inform how to mange women with node positive breast cancer.

Schmid P, Cortes J, Dent R, Pusztai L, McArthur H, Kummel S et al, for the KEYNOTE-522 Investigators.
N Engl J Med 2022; 386: 556-567.

Use of neoadjuvant pembrolizumab plus chemotherapy, with additional pembrolizumab postoperatively improved event-free survival from 76.8 to 84.5 per cent at 36 months in this study that included 1174 women.

Comment: New standard of care?

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).

Lancet Oncol 2022; 23: 382-392.

Aromatase inhibitors were compared with tamoxifen in premenopausal women with ovarian suppression in a study that included 7030 patients followed for a median of eight years. Aromatase inhibitors reduce recurrence, especially in years 1 to 4 (13.2 per cent absolute risk reduction). Recurrence rates were similar in years 5 to 9. Mortality rates were also similar.

Comment: Initial treatment with aromatase inhibitors in this group seems optimal.