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Synopsis The BMJ features a review on traditional herbal medicines for malaria from the 'Research Initiative on Traditional Antimalarial Methods RITAM ; ', whose aim is to further research in this area. This article reviews some of the work done by RITAM and outlines what can be learnt from the developing countries on the management and control of malaria.
The ATAC Trial was a pioneering, international, randomized, double-blind, and placebocontrolled in design and included a total of 9366 postmenopausal women with early-stage breast cancer who were eligible for, but had not received, prior adjuvant hormonal therapy Patients were randomized 1: among the 3 arms of the trial 1. Active ARIMIDEX anastrozole ; plus tamoxifen placebo 2. Active tamoxifen plus ARIMIDEX placebo 3. Active ARIMIDEX plus active tamoxifen The combination arm in ATAC was discontinued due to lack of efficacy at 33 months of follow-up1 No added benefit was observed in efficacy in the combination arm compared with tamoxifen alone2 and atorvastatin.

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B. No significant differences were demonstrated for overall or breast cancerspecific mortality. c. The absolute difference in disease recurrence at 5 years was 2.8%, at 6 years was 3.7%. For every 27 women starting anastrazole, one recurrence was avoided at six years. d. Anstrozole patients had more arthralgias and more fractures, but fewer hot flashes, less endometrial cancer, fewer thromboembolic events, and overall fewer drug withdrawals See Table 2 ; . Adverse Events Hot flashes Arthralgias Endometrial cancer Any fracture Ischemic cardiovascular disease Thromboembolism Drug withdrawal Table 2 Tamoxifen % ; 40.9 29.4 0.8 Nastrozole % ; 35.7 35.6 0.2 P-value 0.0001 0.02 4. Conclusions a. Anwstrozole had better efficacy with respect to disease recurrence and diseasefree survival, and was overall better tolerated than tamoxifen based on drug withdrawals. b. The authors conclude that anastrozole is the preferred initial hormone treatment for postmenopausal early stage hormone-receptor-positive breast cancer. c. The authors suggest switching patients from tamoxifen to an aromatase inhibitor. d. Every author on the writing committee for this trial reported receiving some type of funding from the pharmaceutical company that makes anastrozole. 5. Implications for Patient Care follow Article #2. Article #2: A Randomized Trial of Exemestane After Two to Three Years of Tamoxifen Therapy in Postmenopausal Women with Primary Breast Cancer. Coombes RC, Hall E, Gibson LJ, et al. N Engl J Med 2004; 350: 1081-92. Clinical Summary: This multicenter randomized trial of postmenopausal breast cancer patients tested whether switching to the aromatase inhibitor exemestane after 2-3 years of tamoxifen therapy was more effective than continuing tamoxifen for the remainder of five years total adjuvant hormonal treatment. Women switched to exemestane had better disease-free survival and developed fewer contralateral breast cancers. The absolute difference in disease-free survival was 4.7% at 3 years. Patients taking exemestane had more arthralgias and bone fractures, but less thromboembolism and fewer gynecologic symptoms. While long term efficacy and toxicity information are not available, the use of exemestane will likely increase.

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