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- Title
The Safety Profile of Aromatase Inhibitors Used in Adjuvant Treatment of Breast Cancer.
- Authors
Aapro, Matti S.
- Abstract
Recent large-scale randomised clinical trials in post menopausal women with endocrine-responsive early breast cancer have demonstrated improved disease-free survival (DFS), distant DFS, and reduced contra lateral breast cancer with aromatase inhibitors (AIs) [anastrozole, letrozole and exemestane], as compared to tamoxifen, the earlier standard of care. The benefit of AIs has been demonstrated when used either as initial adjuvant therapy, as an alternative to tamoxifen following 2 to 3 years of adjuvant tamoxifen therapy, or in the extended adjuvant setting after at least 5 years of tamoxifen. In addition, AIs have a more favourable safety profile with a lower incidence of troublesome side-effects such as vaginal bleeding and hot flushes, which often hamper treatment compliance, as well as a reduced risk of potentially life threatening events like venous thromboembolism and endometrial cancer as compared to tamoxifen. The differential impact of AIs and tamoxifen on blood lipids, as indicated in comparative studies, may primarily be driven by a beneficial lipid-lowering effect of tamoxifen, rather than a detrimental effect of AIs. A reduction in bone mineral density is an inevitable consequence of the anti-oestrogenic action of AIs. A careful assessment of risk factors for osteoporosis is thus warranted prior to AI use, and proactive measures such as concomitant biphosphonates or denosumab prescription can greatly reduce the risk of bone loss and associated fracture. Moreover, a combination of lifestyle and pharmacologic approaches has successfully been used to manage musculoskeletal side-effects of AIs. Recent trials have also indicated that AIs do not adversely impact cognition as compared to tamoxifen, although further trials are required to confirm the long-term impact of AIs on cognition. AIs are increasingly gaining favour as the preferred agent for upfront adjuvant therapy or following tamoxifen in postmenopausal women with endocrine-responsive early breast cancer as they have demonstrated improved DFS and in some instances overall survival and a better tolerability profile as compared to tamoxifen alone. A patient specific approach following an in-depth evaluation of individual patient profile and the potential benefits and drawbacks of specific treatment agents is the preferred treatment approach, as supported by several evidence based guidelines.
- Subjects
AROMATASE inhibitors; BREAST cancer; MENSTRUAL cycle; THROMBOEMBOLISM; BLOOD lipids; DISEASES in women; DIAGNOSIS
- Publication
European Journal of Clinical & Medical Oncology, 2010, Vol 2, Issue 4, p9
- ISSN
1759-8958
- Publication type
Article