Resumen:
A previous modeling analysis suggests that postmenopausal breast cancer women with wild-type CYP2D6 (non-CYP2D6*4-allele carriers) might actually have superior disease-free survival (DFS) outcomes when they take tamoxifen rather than an aromatase inhibitor (AI). The present study not only adjusts that original model by the comedication status of CYP2D6-inhibitors but also reconstructs a multiple-genotypebased model, so that an optimizing endocrine therapy for patients harboring wild-type CYP2D6 would be exactly determined. We created Markov models (a modified model and a reconstructed model) to determine whether tamoxifen or AIs maximized 5-year DFS for extensive-metabolizer patients. We also employed twoway sensitivity analyses to explore the impacts of hazard ratio (HR) of decreased metabolizers and frequency of each metabolizer on DFS by studying a range of estimates. In the comedication-adjusted model, the 5-year-DFS of tamoxifen-treated extensive-metabolizer patients was 84.7%, similar to or slightly superior to that for genotypically unselected patients receiving AIs (84.0%). Similarly, in the reconstructed model, the extensive-metabolizer patients also benefited more from tamoxifen than fr...