2002 Guideline
The MEDLINE (from 1966) and CANCERLIT (from 1975) databases were searched to December 2001 using disease-specific terms (breast or mammary, cancer, carcinoma, or neoplasm(s), and metastasis, metastatic, or advanced), treatment-specific terms (anti-aromatase or aromatase inhibitors or endocrine therapy or anastrozole or arimidex or exemestane or aromasin or letrozole or femara or megestrol acetate or aminoglutethimide) and design-specific terms (meta-analysis or randomized controlled trial or randomized controlled trials or random). The searches were not restricted by language of publication. Issue 2 (2002) of the Cochrane Library, the Physician Data Query database, clinical trial and practice guideline Internet sites, conference proceedings from the American Society of Clinical Oncology (ASCO) (1997-2001), the European Society for Medical Oncology (1998-2000) and the San Antonio Breast Cancer Symposium (2000-2001), bibliographies, and personal files were also searched.
An update search of the Medline database and the proceedings of the 2002 American Society of Clinical Oncology meeting were conducted in June 2002, after the practitioner feedback survey.
2003 Update
The original literature search has been updated using MEDLINE and CANCERLIT (through October 2003), the Cochrane Library (Issue 4, 2003), the Physician Data Query database, clinical trial and practice guideline Internet sites, proceedings of the annual meeting of ASCO (2003), proceedings of ESMO (2001-2002), and proceedings of the San Antonio Breast Cancer Symposium (2002).
Inclusion Criteria
Articles were selected for inclusion if they met the following criteria:
- Selective aromatase inhibitors as first-, second- or third-line hormonal therapy in postmenopausal patients with stage IV breast cancer were evaluated using a randomized controlled design, meta-analysis, evidence-based clinical practice guideline format, or noncomparative design (in the absence of randomized controlled trials).
- Reported outcomes of interest included survival, quality of life, tumour response, time to disease progression, and adverse effects of treatment.
- Clinical trial results were reported in either full papers or abstracts. Although data presented in meeting abstracts may not be as reliable and complete as that from papers published in peer-reviewed journals, abstracts can be a source of important evidence from randomized trials and can add to the evidence available from fully published studies. These data often appear first in meeting abstracts and may not be published for several years.
Exclusion Criteria
Articles excluded from this systematic review included:
- Trials of aminoglutethimide (a first-generation aromatase inhibitor) compared to non-aromatase-inhibitor hormonal therapies.
- Trials of fulvestrant, formestane, vorozole or fadrozole, selective aromatase inhibitors that are not available in Ontario.
- Trials of aromatase inhibitors as adjuvant or neo-adjuvant therapy.
- Letters and editorials.