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Nolvadex

Clinical Pharmacology
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Clinical Pharmacology

Survival was similar in the placebo and NOLVADEX groups. At 5 years from study entry, survival was 97% for both groups.

Reduction in Breast Cancer Incidence in High Risk Women:

The Breast Cancer Prevention Trial (BCPT, NSABP P-1) was a double-blind, randomized, placebo-controlled trial with a primary objective to determine whether 5 years of NOLVADEX therapy (20 mg/day) would reduce the incidence of invasive breast cancer in women at high risk for the disease (See INDICATIONS AND USAGE). Secondary objectives included an evaluation of the incidence of ischemic heart disease; the effects on the incidence of bone fractures; and other events that might be associated with the use of NOLVADEX, including: endometrial cancer, pulmonary embolus, deep vein thrombosis, stroke, and cataract formation and surgery (See WARNINGS).

The Gail Model was used to calculate predicted breast cancer risk for women who were less than 60 years of age and did not have lobular carcinoma in situ (LCIS). The following risk factors were used: age; number of first-degree female relatives with breast cancer; previous breast biopsies; presence or absence of atypical hyperplasia; nulliparity; age at first live birth; and age at menarche. A 5-year predicted risk of breast cancer of ≥ 1.67% was required for entry into the trial.

In this trial, 13,388 women of at least 35 years of age were randomized to receive either NOLVADEX or placebo for five years. The median duration of treatment was 3.5 years. As of January 31, 1998, follow-up data is available for 13,114 women. Twenty-seven percent of women randomized to placebo (1,782) and 24% of women randomized to NOLVADEX (1,596) completed 5 years of therapy. The demographic characteristics of women on the trial with follow-up data are shown in Table 2.

Table 2. Demographic Characteristics of Women in the NSABP P-1 Trial

Characteristic Placebo Tamoxifen
  # % # %
Age (yrs.)
  35-39 184 3 158 2
  40-49 2,394 36 2,411 37
  50-59 2,011 31 2,019 31
  60-69 1,588 24 1,563 24
   ≥ 70 393 6 393 6
Age at first live birth (yrs.)
Nulliparous 1,202 18 1,205 18
  12-19 915 14 946 15
  20-24 2,448 37 2,449 37
  25-29 1,399 21 1,367 21
  ≥ 30 606 9 577 9
Race
White 6,333 96 6,323 96
Black 109 2 103 2
Other 128 2 118 2
Age at menarche
   ≥ 14 1,243 19 1,170 18
  12-13 3,610 55 3,610 55
   ≤ 11 1,717 26 1,764 27
# of first degree relatives with breast cancer
  0 1,584 24 1,525 23
  1 3,714 57 3,744 57
  2+ 1,272 19 1,275 20
Prior Hysterectomy
  No 4,173 63.5 4,018 62.4
  Yes 2,397 36.5 2,464 37.7
# of previous breast biopsies
  0 2,935 45 2,923 45
  1 1,833 28 1,850 28
   ≥ 2 1,802 27 1,771 27
History of atypical hyperplasia in the breast
  No 5,958 91 5,969 91
  Yes 612 9 575 9
History of LCIS at entry
  No 6,165 94 6,135 94
  Yes 405 6 409 6
5-year predicted breast cancer risk (%)
   ≤ 2.00 1,646 25 1,626 25
  2.01-3.00 2,028 31 2,057 31
  3.01-5.00 1,787 27 1,707 26
   ≥ 5.01 1,109 17 1,162 18
Total 6,570 100.0 6,544 100.0

Brand Name: Nolvadex
Generic Name: Tamoxifen Citrate
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