The STOPHER Trial Does Not Exist in Breast Cancer Literature
There is no published clinical trial called "STOPHER" (Selective Targets Overcoming Postmenopausal Hormone-sensitive breast cancer Resistance) in the breast cancer literature. The provided evidence contains no references to any trial by this name, and this appears to be either a misremembered trial name or a non-existent study.
Major Adjuvant Endocrine Therapy Trials You May Be Thinking Of
The landmark trials that have shaped adjuvant endocrine therapy for hormone receptor-positive breast cancer include:
Primary Adjuvant Aromatase Inhibitor Trials
- ATAC Trial (Arimidex, Tamoxifen, Alone or in Combination): Compared anastrozole versus tamoxifen versus combination therapy for 5 years in 9,366 postmenopausal women, showing superior disease-free survival with anastrozole (HR 0.87,95% CI 0.78-0.97, P=0.01) 1, 2
- BIG 1-98 Trial: Demonstrated letrozole superiority over tamoxifen for disease-free survival (HR 0.81,95% CI 0.70-0.93, P=0.003) 2
Sequential Therapy Trials
- IES Trial (Intergroup Exemestane Study): Compared switching to exemestane after 2-3 years of tamoxifen versus continuing tamoxifen, showing improved disease-free survival with the switch (HR 0.68,95% CI 0.56-0.82, P=0.00005) 1
- TEAM Trial (Tamoxifen Exemestane Adjuvant Multinational): Compared exemestane monotherapy versus sequential tamoxifen followed by exemestane, finding no difference in disease-free survival at 5 years (HR 0.97,95% CI 0.88-1.08, P=0.60), confirming both strategies as reasonable options 3, 4
- ITA Trial (Italian Tamoxifen Anastrozole): Evaluated switching to anastrozole after 2-3 years of tamoxifen 1
- ABCSG 8/ARNO 95 Trials: Austrian and German trials examining sequential therapy strategies 1
Extended Therapy Trials
- MA.17 Trial: Enrolled 5,187 postmenopausal women who completed 4.5-6 years of tamoxifen and randomized them to letrozole versus placebo for 5 additional years, showing superior disease-free survival (94.4% vs 89.8%, HR 0.58, P<0.001) and improved overall survival specifically in node-positive patients (HR 0.61,95% CI 0.38-0.98, P=0.04) 1, 2
Premenopausal Trials
- TEXT/SOFT Trials (Tamoxifen and Exemestane Trial/Suppression of Ovarian Function Trial): Demonstrated that premenopausal women with high recurrence risk may experience 10-15% absolute improvement in 8-year freedom from distant recurrence with exemestane plus ovarian function suppression versus tamoxifen alone 5
Current Guideline Recommendations Based on These Trials
The NCCN explicitly recommends aromatase inhibitors preferentially over tamoxifen alone in postmenopausal women with hormone receptor-positive breast cancer 2. Three acceptable strategies exist:
- Initial adjuvant therapy: Aromatase inhibitor for 5 years 2
- Sequential therapy: 2-3 years of tamoxifen followed by aromatase inhibitor to complete 5 years total 1, 2
- Extended therapy: Aromatase inhibitor after completing 4.5-6 years of tamoxifen 1, 2
Common Pitfall to Avoid
Do not confuse trial acronyms—the major trials are ATAC, BIG 1-98, IES, TEAM, MA.17, TEXT, and SOFT. No "STOPHER" trial exists in the published literature 1, 2.