Aromatase inhibitor therapy: toxicities and management strategies in the treatment of postmenopausal women with hormone-sensitive early breast cancer

Dent, Susan; Gaspo, Rania; Kissner, Michelle; Pritchard, Kathleen I.

doi:10.1007/s10549-011-1351-3

Cited by 85 publications

(56 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In several studies, AIs use was associated with a higher risk of arthralgia and decreased BMD compared to TAM, and the incidence of discontinuation ranges from approximately 12% to 14% [16] . Effects on cognitive function related to the AIs use have also been reported, similar to the so-called "chemotherapy fog" observed following prolonged cancer CT [71] . However, toxicity is related to individual treatment compliance and depends on the way in which the patient describes and reports the symptoms, and they usually resolve with discontinuation of treatment [16] .…”

Section: Adverse Effectsmentioning

confidence: 64%

Current medical treatment of estrogen receptor-positive breast cancer

Lumachi

Santeufemia

Basso

2015

WJBC

167

126

View full text Add to dashboard Cite

Approximately 80% of breast cancers (BC) are estrogen receptor (ER)-positive and thus endocrine therapy (ET) should be considered complementary to surgery in the majority of patients. The advantages of oophorectomy, adrenalectomy and hypophysectomy in women with advanced BC have been demonstrated many years ago, and currently ET consist of (1) ovarian function suppression (OFS), usually obtained using gonadotropinreleasing hormone agonists (GnRHa); (2) selective estrogen receptor modulators or down-regulators (SERMs or SERDs); and (3) aromatase inhibitors (AIs), or a combination of two or more drugs. For patients aged less than 50 years and ER+ BC, there is no conclusive evidence that the combination of OFS and SERMs (i.e. , tamoxifen) or chemotherapy is superior to OFS alone. Tamoxifen users exhibit a reduced risk of BC, both invasive and in situ , especially during the first 5 years of therapy, and extending the treatment to 10 years further reduced the risk of recurrences. SERDs (i.e. , fulvestrant) are especially useful in the neoadjuvant treatment of advanced BC, alone or in combination with either cytotoxic agents or AIs. There are two types of AIs: type Ⅰ are permanent steroidal inhibitors of aromatase, while type Ⅱ are reversible nonsteroidal inhibitors. Several studies demonstrated the superiority of the third-generation AIs (i.e. , anastrozole and letrozole) compared with tamoxifen, and adjuvant therapy with AIs reduces the recurrence risk especially in patients with advanced BC. Unfortunately, some cancers are or became ET-resistant, and thus other drugs have been suggested in combination with SERMs or AIs, including cyclin-dependent kinase 4/6 inhibitors (palbociclib) and mammalian target of rapamycin (mTOR) inhibitors, such as everolimus. Further studies are required to confirm their real usefulness.

show abstract

Section: Adverse Effectsmentioning

confidence: 64%

Current medical treatment of estrogen receptor-positive breast cancer

Lumachi

Santeufemia

Basso

2015

WJBC

167

126

View full text Add to dashboard Cite

show abstract

“…Meta-analyses indicate that the vast majority (!90%) of ER þ LN À tamoxifen-treated patients are diseasefree at 5 years, and therefore a decision is required whether to provide extended adjuvant endocrine therapy. Individual patient risk of distant recurrence at 5 years is of clinical importance given the comorbidities associated with endocrine therapies (24) and the recent results from the IDEAL randomized trial of extended endocrine therapy showing high patient noncompliance due to toxicities (25). Results reported herein indicate that BCI low-risk patients assessed at diagnosis continue to have a low probability of distant recurrence after 5 years, and therefore may be recommended to forgo extended therapy, whereas patients with BCI high risk may benefit from extended therapy.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Index Identifies Early-Stage Estrogen Receptor–Positive Breast Cancer Patients at Risk for Early- and Late-Distant Recurrence

Zhang

Schnabel

Schroeder

et al. 2013

Clinical Cancer Research

200

179

View full text Add to dashboard Cite

Purpose: Residual risk of relapse remains a substantial concern for patients with hormone receptorpositive breast cancer, with approximately half of all disease recurrences occurring after five years of adjuvant antiestrogen therapy.Experimental Design: The objective of this study was to examine the prognostic performance of an optimized model of Breast Cancer Index (BCI), an algorithmic gene expression-based signature, for prediction of early (0-5 years) and late (>5 years) risk of distant recurrence in patients with estrogen receptor-positive (ER þ ), lymph node-negative (LN À ) tumors. The BCI model was validated by retrospective analyses of tumor samples from tamoxifen-treated patients from a randomized prospective trial (Stockholm TAM, n ¼ 317) and a multi-institutional cohort (n ¼ 358).Results: Within the Stockholm TAM cohort, BCI risk groups stratified the majority ($65%) of patients as low risk with less than 3% distant recurrence rate for 0 to 5 years and 5 to 10 years. In the multi-institutional cohort, which had larger tumors, 55% of patients were classified as BCI low risk with less than 5% distant recurrence rate for 0 to 5 years and 5 to 10 years. For both cohorts, continuous BCI was the most significant prognostic factor beyond standard clinicopathologic factors for 0 to 5 years and more than five years.Conclusions: The prognostic sustainability of BCI to assess early-and late-distant recurrence risk at diagnosis has clinical use for decisions of chemotherapy at diagnosis and for decisions for extended adjuvant endocrine therapy beyond five years. Clin Cancer Res; 19(15); 4196-205. Ó2013 AACR.

show abstract

“…Studies have identified, with often conflicting results, that factors associated with poor adherence to breast cancer therapy such as type of breast cancer surgery (16,17), severity of side effects (18,19), number of tablets (20)(21)(22), age (11-13, 15, 20, 23, 24), depression and/or the use of antidepressants (24,25), socioeconomic disadvantage (26,27), smoking (28), the impact of breast cancer therapy on quality of life, and the perceived riskbenefit ratio (29).…”

Section: Introductionmentioning

confidence: 99%

Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort

Markkula

Hietala

Henningson

et al. 2012

Cancer Prevention Research

View full text Add to dashboard Cite

Nonadherence to adjuvant endocrine breast cancer treatment adversely affects disease-free and overall survival. Clinical predictors of nonadherence may allow for specific interventions to reduce nonadherence and improve survival. The aim was to investigate whether clinical characteristics predict nonadherence. Clinical characteristics and information on adherence were obtained from 417 patients with breast cancer in a population-based prospective cohort from southern Sweden using patient charts, pathology reports, and questionnaires filled out at the 1-and 2-year follow-up visits. At the 1-and 2-year follow-up visits, 36 (8.6%) and 33 (9.7%) patients were nonadherent, respectively. Thirteen of the nonadherent patients declined treatment and were never prescribed endocrine treatment. A body mass index (BMI) < 25 kg/m 2 , preoperative current smoking, and drinking alcohol less often than twice a month predicted nonadherence at the 1-year [relative risk (RR), 5.24; 95% confidence interval (CI), 2.75-9.97] and the 2-year visits (RR, 4.07; 95% CI, 2.11-7.84) in patients with at least two of these clinical characteristics. When low histologic grade (I) was added to the model, having at least two of these four clinical characteristics predicted nonadherence at the 1-year (RR, 4.94; 95% CI, 2.46-10.00) and the 2-year visits (RR, 4.74; 95% CI, 2.28-9.87), the two profiles had a sensitivity ranging from 60.6% to 72.7%, whereas the specificity ranged from 68.0% to 78.4%. Nonadherence at the 1-year visit was associated with an increased risk for early breast cancer events (HR, 2.97; 95% CI, 1.08-8.15), adjusted for age and tumor characteristics. In conclusion, two clinical profiles predicted early nonadherence and may allow for targeted interventions to increase adherence if validated in an independent cohort. Cancer Prev Res; 5(5); 735-45. Ó2012 AACR.

show abstract

Aromatase inhibitor therapy: toxicities and management strategies in the treatment of postmenopausal women with hormone-sensitive early breast cancer

Cited by 85 publications

References 99 publications

Current medical treatment of estrogen receptor-positive breast cancer

Current medical treatment of estrogen receptor-positive breast cancer

Breast Cancer Index Identifies Early-Stage Estrogen Receptor–Positive Breast Cancer Patients at Risk for Early- and Late-Distant Recurrence

Clinical Profiles Predict Early Nonadherence to Adjuvant Endocrine Treatment in a Prospective Breast Cancer Cohort

Contact Info

Product

Resources

About