Letrozole (Femara®)

Following a full submission

Letrozole (Femara) is accepted for restricted use within NHS Scotland for the treatment of invasive early breast cancer in postmenopausal women who have received prior standard adjuvant tamoxifen therapy.

Treatment should continue for 3 years or until tumour relapse, whichever occurs first. Following 5 years of adjuvant tamoxifen therapy the risk of recurrence (in ipsilateral breast, new tumour in contralateral breast or distance metastases) occurs at an aggregate rate of 2- 3% per year. The use of letrozole as extended adjuvant treatment resulted in a 43% lower risk of recurrence compared with placebo. However, a significant difference for overall survival, defined as time to death from any cause, was seen in lymph-node positive patients only.

Clinicians and patients should consider the residual risk of recurrence, individual preferences and the risks and benefits of treatment.

Letrozole is restricted to initiation to breast cancer specialists.