The PBS restriction for two aromatase inhibitors, exemestane and letrozole, was extended on 1 December 2006 to include adjuvant treatment of hormone-dependent early breast cancer in postmenopausal women. These drugs were previously listed as restricted benefits for advanced breast cancer only — the new listings bring them into line with anastrozole (Arimidex), which is also available on the PBS for early breast cancer [refer to the NPS RADAR review "Anastrozole (Arimidex) for the treatment of hormone-dependent early breast cancer in postmenopausal women" (December 2005 issue)].
Exemestane may be prescribed on the PBS for hormone-dependent early breast cancer after a minimum of 2 years' treatment with tamoxifen. Letrozole may be prescribed as initial adjuvant hormonal treatment or be started after 2-3 years of tamoxifen.1 The total duration of PBS-subsidised adjuvant hormonal treatment with an aromatase inhibitor (or with tamoxifen followed by an aromatase inhibitor) should not exceed 5 years.
