Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

Abstract

To cite this version:Karine Abstract The objective of the present study was to evaluate the effect of the switch of aromatase inhibitors (AIs) on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer. This was a 6-month, prospective, non-randomized, multicenter study. Patients who had discontinued anastrozole due to musculoskeletal symptoms were eligible to participate in this study, and received letrozole, which was initiated 1 month after anastrozole discontinuation. Musculoskeletal symptoms were systematically assessed for severity, location of the symptoms, presence of swelling and of morning stiffness by the oncologist patients when patients stopped taking their anastrozole, 1 month after the discontinuation of anastrozole, and 1, 3, and 6 months after initiating the letrozole therapy. The primary endpoint was the percentage of patients who discontinued letrozole due to the severe musculoskeletal symptoms. After switching from anastrozole therapy, and at the end of the 6-month letrozole treatment, 128 (71.5%) out of 179 patients (61.3 ± 8.4 years) continued with letrozole. Fifty-one patients (28.5%) discontinued treatment due to severe joint pain. At the end of the 6-month, 116 patients (73.9%) had arthralgia, 33 (21.0%) myalgia, 25 (15.9%) arthritis, 22 (14.0%) tendinitis, and 20 (12.7%) polyalgic syndrome. Bivariate analysis of the factors associated with letrozole discontinuation showed that the duration of a prior anastrozole treatment was a significant predictor (P = 0.04). This study shows that in patients intolerant to one AI, switching to another agent allows a higher proportion of patients to continue the therapy and maximize hormonal adjuvant therapy and disease outcome benefits.

Adherence to oral endocrine treatments in women with breast cancer: can it be improved?

“…Thus, in a small study of 179 women, who had discontinued treatment with anastrozole due to musculoskeletal pain, were then treated with letrozole. After 6 months, 72% of these women were continuing with letrozole, despite only a small decrease in the pain [57]. Similar results have been produced in the REAL (Rheumatologic Evaluation of Adjuvant Letrozole in Postmenopausal women with Breast Cancer trial) study [58].…”

“…The education should include the name of the medication, dose and schedule, how the medication is taken, safety, and side effects and symptom management [60]. For dosing and scheduling, reminders may be recommended [57]. Individuals learn in different ways, and repetition can help reinforce important messages [62].…”

Predictors of Aromatase Inhibitor Discontinuation as a Result of Treatment-Emergent Symptoms in Early-Stage Breast Cancer

“…11 These data suggest that individual patient differences may dictate intolerance to one but not another AI. Some studies have suggested that development of adverse effects may be associated with obesity, prior chemotherapy, and no prior tamoxifen therapy.…”

Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis

“…In the study of switch therapy by Briot et al (46), the primary outcome was the percentage of women who discontinued letrozole secondary to musculoskeletal symptoms, after switching from anastrozole. Likewise, in the study of switch therapy by Kadakia et al, the primary outcome was tolerance of, and persistence with aromatase inhibitors (45).…”