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Early improvements in disease-free survival have been noted when an aromatase inhibitor is given either instead of or sequentially after tamoxifen in postmenopausal women with oestrogen-receptor-positive early breast cancer. However, little information exists on the long-term effects of aromatase inhibitors after treatment, and whether these early improvements lead to real gains in survival. 4724 postmenopausal patients with unilateral invasive, oestrogen-receptor-positive or oestrogen-receptor-unknown breast cancer who were disease-free on 2–3 years of tamoxifen, were randomly assigned to switch to exemestane (n=2352) or to continue tamoxifen (n=2372) for the remainder of a 5-year endocrine treatment period. The primary endpoint was disease-free survival; overall survival was a secondary endpoint. Efficacy analyses were intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN11883920. After a median follow-up of 55·7 months (range 0–89·7), 809 events contributing to the analysis of disease-free survival had been reported (354 exemestane, 455 tamoxifen); unadjusted hazard ratio 0·76 (95% CI 0·66–0·88, p=0·0001) in favour of exemestane, absolute benefit 3·3% (95% CI 1·6–4·9) by end of treatment (ie, 2·5 years after randomisation). 222 deaths occurred in the exemestane group compared with 261 deaths in the tamoxifen group; unadjusted hazard ratio 0·85 (95% CI 0·71–1·02, p=0·08), 0·83 (0·69–1·00, p=0·05) when 122 patients with oestrogen-receptor-negative disease were excluded. Our results suggest that early improvements in disease-free survival noted in patients who switch to exemestane after 2–3 years on tamoxifen persist after treatment, and translate into a modest improvement in overall survival.

This large randomized trial compared the standard adjuvant treatment for early breast cancer in postmenopausal women, five years of therapy with tamoxifen (an inhibitor of the estrogen receptor), with two to three years of tamoxifen followed by therapy with exemestane, an aromatase inhibitor, for the balance of the five-year period. Disease-free survival was significantly better in the exemestane group than in the tamoxifen group. Sequential use of antiestrogen compounds with different mechanisms may obviate the problem of resistance to tamoxifen. Breast cancer is estrogen-dependent in many cases, and reducing the estrogen levels by means of ovariectomy can cause regression of established disease, 1 especially if the tumor is rich in estrogen receptors. 2 The selective estrogen-receptor modulator tamoxifen blocks the action of estrogen by binding to one of the activating regions of the estrogen receptor. 3 , 4 When given to women with estrogen-receptor–positive breast cancer for five years after surgery, tamoxifen reduces the risk of recurrence by 47 percent and the risk of death by 26 percent. 5 The risk–benefit ratio of using tamoxifen for longer than five years remains unclear, 6 , 7 and trials . . .

In this randomized trial, patients who had unresectable stage III or IV squamous-cell head and neck cancer with no distant metastases were assigned to receive induction treatment with docetaxel plus cisplatin and fluorouracil (TPF) or cisplatin and fluorouracil (PF) before receiving chemoradiotherapy. Patients who received TPF induction chemotherapy had significantly longer survival than did patients who received PF induction chemotherapy. Patients who received TPF induction chemotherapy had significantly longer survival than did patients who received cisplatin and fluorouracil induction chemotherapy. Squamous-cell carcinoma of the head and neck accounts for 5% of newly diagnosed cancers in adults in the United States and 8% of cancers worldwide. 1 The disease is potentially curable at an early stage, but most patients present with locally advanced disease. After standard therapy (surgery and irradiation), only 30 to 50% of patients with locally advanced disease live for 3 years, and locoregional recurrences or distant metastases develop in 40 to 60% of them. 2 – 6 Various strategies to improve outcomes by coordinating chemotherapy with surgery and radiotherapy have been tried, but the optimal schedule for integrating chemotherapy into the . . .

Winning elections is so vital for Russian leaders that competing viewpoints on national television news channels have been scotched, together with the channels that broadcast them. This study examines the other side of the screen: how participants in focus groups in four Russian cities process national channels' treatments of an important regional electoral campaign. The study was conducted during the last period in which viewpoint diversity was still available via TV-6. Unlike findings about other news stories, election stories appear to have little connection to viewers' experiences and values and deprive them of using familiar heuristics to make sense of the stories. For the public, the election story is a genre apart, framed by the same confusing template no matter what the office or region. Even TV-6, soon to be shuttered, broadcast its combative message using that template, thus extinguishing any opportunity for identifying genuine diversity and leaving the audience unable to distinguish between state and private channels, something they easily did for other types of stories. Election stories only cue other election stories. It is mainly younger, \"post-Soviet\" participants who bring an alternative frame to watching: norms, acquired through their education, by which election stories in a democracy ought to be constructed.

Using data from a national public opinion survey carried out in the Soviet Union during November and December 1989, we explore two attitudes relevant to the revolutionary changes there: (1) attitudes toward change and political democracy and (2) attitudes toward a core component of socialist ideology, the locus of responsibility for social well-being (the state or individuals?). These variables are unrelated, with the sample relatively evenly divided among the intersecting cells of a cross tabulation. While social conflict may be mitigated by the small sizes of absolutely opposing groups, consensus may also be hard to reach. Ethnicity, education, income, age, party membership, and life satisfaction have important effects on these attitudes. We discuss how attitude patterns in our data may be related to the disintegration of the Soviet Union and to problems faced by the independent successor states as they develop new institutions and foster new values.

Objectives: To assess the efficacy and tolerability of gemcitabine and paclitaxel as first-line treatment in advanced breast cancer. Methods: Patients with histologically confirmed metastatic or metastatic plus locally advanced breast cancer received gemcitabine 1,200 mg/m 2 on days 1 and 8 and paclitaxel 175 mg/m 2 on day 1 every 21 days for 8 cycles. Results: From December 1999 to August 2001, 45 patients, with a median age of 53.5 years (range, 22–77), received a total of 260 cycles. All were assessable for response and toxicity. Twenty-seven patients had prior adjuvant therapy. Hormonal receptor status was positive in 31.1% and negative in 40.0% of patients. Main metastatic sites included soft tissue (62.2%) and lung (53.3%). The objective response rate was 66.7%; complete response, 22.2%; partial response, 44.4%; stable disease, 15.6%; progressive disease, 17.8%. Median duration of response was 18 months and median time to tumor progression was 11 months. Grade 3/4 leukopenia, neutropenia, and thrombocytopenia developed in 13.3% of patients, and 15.5% developed grade 3/4 mucositis. No treatment-related deaths occurred. Median overall survival was 19 months. Conclusion: Gemcitabine plus paclitaxel is an active combination with a favorable toxicity profile as first-line treatment for patients with advanced breast cancer.

Coombes et al seek to compare switching to exemestane after 2-3 years of tamoxifen with ongoing tamoxifen as adjuvant therapy for early-stage breast cancer in postmenopausal women. The primary endpoint was disease-free survival measured from the time of randomization. A commentary by Warren and Steer regarding the study is further presented.

USING DATA FROM A NATIONAL PUBLIC OPINION SURVEY CONDUCTED IN THE SOVIET UNION DURING NOVEMBER AND DECEMBER 1989, THE AUTHORS EXPLORE TWO ATTITUDES RELEVANT TO THE REVOLUTIONARY CHANGES THERE: (1) ATTITUDES TOWARD CHANGE AND POLITICAL DEMOCRACY AND (2) ATTITUDES TOWARD A CORE COMPONENT OF SOCIALIST IDEOLOGY, THE LOCUS OF RESPONSIBILITY FOR SOCIAL WELL-BEING (THE STATE OR INDIVIDUALS?). THESE VARIABLES ARE UNRELATED, WITH THE SAMPLE RELATIVELY EVENLY DIVIDED AMONG THE INTERSECTING CELLS OF A CROSS-TABULATION. WHILE SOCIAL CONFLICT MAY BE MITIGATED BY THE SMALL SIZES OF ABSOLUTELY OPPOSING GROUPS, CONSENSUS MAY ALSO BE HARD TO REACH. ETHNICITY, EDUCATION, INCOME, AGE, PARTY MEMBERSHIP, AND LIFE SATISFACTION HAVE IMPORTANT EFFECTS ON THESE ATTITUDES. THE AUTHORS DISCUSS HOW ATTITUDE PATTERNS IN THE DATA MAY BE RELATED TO THE DISINTEGRATION OF THE USSR AND TO PROBLEMS FACED BY THE INDEPENDENT SUCCESSOR STATES AS THEY DEVELOP NEW INSTITUTIONS AND FOSTER NEW VALUES.