Exemestane for Breast-Cancer Prevention in Postmenopausal Women

Goss, Paul E.; Ingle, James N.; Alés‐Martínez, José E.; Cheung, Angela M.; Chlebowski, Rowan T.; Wactawski‐Wende, Jean; McTiernan, Anne; Robbins, John A.; Johnson, Karen C.; Martin, Lisa W.; Winquist, Eric; Sarto, Gloria E.; Garber, Judy E.; Fabian, Carol J.; Pujol, Pascal; Maunsell, Elizabeth; Farmer, Patricia; Gelmon, Karen A.; Tu, Dongsheng; Richardson, Harriet

doi:10.1056/nejmoa1103507

Cited by 857 publications

(621 citation statements)

References 45 publications

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“…Medication toxicity has been suggested to be the major obstacle that reduces women's adherence to tamoxifen treatment. Nevertheless, other proven, less-toxic chemopreventive medications, including raloxifene and AIs, are also associated with adherence problems, including close to 30% dropout rates, in 2 recent randomized trials (40,41), suggesting that factors other than adverse events and side effects also contribute to nonadherence. The recent adherence analysis by Land and colleagues suggests that young age and current smoking, among other factors, predict poor adherence to tamoxifen chemoprevention.…”

Section: Resultsmentioning

confidence: 99%

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Zhang

Manson

2011

Cancer Prevention Research

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Treatment with the selective estrogen receptor modulator (SERM) tamoxifen for 5 years has produced dramatic breast cancer-related benefits in (a) the adjuvant setting, with 30% to 50% reductions in recurrence, contralateral disease, and mortality and (b) the prevention setting of healthy high-risk women, where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50%. Despite these striking data, adherence to tamoxifen is low, and low adherence is associated with poor survival. Although toxicity is a major predictor of poor adherence after starting therapy, pretreatment (baseline) predictors of poor tamoxifen adherence have been minimally studied. The adherence-survival link underscores the critical need to identify early predictors of poor adherence, and recent work is beginning to address this need. A major baseline predictor of poor adherence to prevention is current smoking, which is interestingly absent from studies of adherence to adjuvant therapy. Other important prevention adherence factors include breast cancer risk, extremes of age, non-white ethnicity, low socioeconomic status, and alcohol use. The strongest adjuvant therapy predictors are age (especially very young), ethnicity, and socioeconomic status. Future studies involving prospective systematic evaluation of these and other potential predictors in endocrine chemoprevention (e.g., other SERMs and aromatase inhibitors) are critical, as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women.

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Section: Resultsmentioning

confidence: 99%

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Zhang

Manson

2011

Cancer Prevention Research

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“…The drug was administered for 5 years and was well tolerated by study participants. 10 Adverse effects and risks commonly associated with aromatase inhibitors include osteoporosis, fatigue, exacerbation of vasomotor symptoms, and vaginal dryness. In contrast to raloxifene and tamoxifen, there does not seem to be any evidence of increased vascular or thrombotic risk associated with aromatase inhibitors.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to raloxifene and tamoxifen, there does not seem to be any evidence of increased vascular or thrombotic risk associated with aromatase inhibitors. 10 It is essential that the decision to initiate chemopreventive therapy be individualized, taking into account comorbid conditions and breast cancer risk.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Pearls in Breast Disease

Pruthi

Bundrick

Litin

2012

Mayo Clinic Proceedings

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“…Due to this, the MAP3 trial does not allow for any conclusions on the long term safety and efficacy of this drug. 42 The aim of the IBIS-II trial was to evaluate the efficacy and safety of anastrozole for breast cancer prevention in high-risk postmenopausal women. The IBIS-II assessed only anastrozole versus placebo due to more effective action of anastrozole in breast cancer chemoprevention of postmenopausal women compared to tamoxifen.…”

Section: Chemopreventionmentioning

confidence: 99%

Use of anastrozole in the chemoprevention and treatment of breast cancer: A literature review

Barros-Oliveira

Costa‐Silva

Andrade

et al. 2017

Rev. Assoc. Med. Bras.

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Aromatase inhibitors have emerged as an alternative endocrine therapy for the treatment of hormone sensitive breast cancer in postmenopausal women. The use of third-generation inhibitors represented by exemestane, letrozol and anastrozole is currently indicated. Anastrozole is a nonsteroidal compound and a potent selective inhibitor of the aromatase enzyme. Although a few studies have shown that its pharmacodynamic and pharmacokinetic properties may be affected by interindividual variability, this drug has been recently used in all configurations of breast cancer treatment. In metastatic disease, it is currently considered the first-line treatment for postmenopausal women with estrogen receptor-positive breast tumors. Anastrozole has shown promising results in the adjuvant treatment of early-stage breast cancer in postmenopausal women. It has also achieved interesting results in the chemoprevention of the disease. Therefore, due to the importance of anastrozole both for endocrine treatment and chemoprevention of hormone-sensitive breast cancer in postmenopausal women, we proposed the current literature review in the SciELO and PubMed database of articles published in the last 10 years.

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Exemestane for Breast-Cancer Prevention in Postmenopausal Women

Cited by 857 publications

References 45 publications

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Clinical Pearls in Breast Disease

Use of anastrozole in the chemoprevention and treatment of breast cancer: A literature review

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