Toxicity of aromatase inhibitors may explain lack of overall survival improvement
The toxicities associated with aromatase inhibitors (AIs) may explain the lack of overall survival improvement compared with tamoxifen, according to a study published August 22 in the Journal of The National Cancer Institute.
AIs are a class of drugs used to treat breast cancer in postmenopausal women. The drugs are normally taken as an alternative to tamoxifen or after initial treatment with tamoxifen. In general, they are associated with as reduction in breast cancer recurrence but not in improved survival. Furthermore, the drugs are associated with a number of concerning adverse toxic effects compared with tamoxifen.
To examine whether the relative toxicity of AIs versus tamoxifen may explain the lack of overall survival benefit in postmenopausal breast cancer patients, Eitan Amir, MB ChB, of the Division of Medical Oncology and Hematology at Princess Margaret Hospital in Toronto, Ontario and colleagues conducted a systematic review to identify all randomized trials which compared AIs and tamoxifen in postmenopausal women. They then performed a meta-analysis of the data from the selected randomized trials. Their meta-analysis used data from seven trials enrolling 30,023 patients.
The researchers found that compared to tamoxifen, longer use of AIs was associated with increased heart disease and bone fractures, but lower rates of blood clots and cancer of the womb. There were no differences in the risk of stroke or other types of cancer. Furthermore, use of AIs for 2-3 years after initial treatment with tamoxifen was associated with a lower risk of death unrelated to breast cancer compared to the use of either AIs or tamoxifen alone. The authors therefore concluded that the toxicity of AIs when used for longer periods of treatment may explain the lack of overall survival benefit while still having a positive effect on breast cancer recurrence.
The researchers write, "The cumulative toxicity of aromatase inhibitors when used as up-front treatment may explain the lack of overall survival benefit despite improvements in disease-free survival. Switching from tamoxifen to aromatase inhibitors reduces this toxicity and is likely the best balance between efficacy and toxicity."
In an accompanying editorial, Nancy E. Davidson, M.D., Shannon Puhalla, M.D., and Rachel C. Jankowitz, M.D., of the UPMC Cancer Center at Magee-Womens Hospital, write that, "survival benefits with adjuvant tamoxifen were not truly evident until after 5 years of follow-up. Thus, it is conceivable that a late survival advantage with aromatase inhibitors over tamoxifen may also emerge over time."
The editorialists conclude that doctors should, "choose initial endocrine therapy for the individual patient with careful attention to the risk of breast cancer recurrence, the risk of toxicity, and comorbidities."
Provided by
Journal of the National Cancer Institute
-
Aromatase inhibitors increased risk of heart disease in postmenopausal women with breast cancer
Dec 09, 2010 |
not rated yet |
0
-
Meta-analyses of global trials finds in favor of aromatase inhibitors
Dec 11, 2008 |
not rated yet |
0
-
Novel basis identified for tamoxifen failure
Dec 04, 2008 |
not rated yet |
0
-
Goserelin improves long-term survival in premenopausal women with early breast cancer
Feb 24, 2009 |
not rated yet |
0
-
Drug's lasting benefits sees breast cancer deaths down by third
Jul 29, 2011 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013
-
If you became brain-dead, would you want them to pull the plug?
May 17, 2013
-
MRI bill question
May 15, 2013
-
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013
-
Alcohol and acetaminophen
May 13, 2013
-
Marie Curie's leukemia
May 13, 2013
- More from Physics Forums - Medical Sciences
More news stories
New smartphone application improves colonoscopy preparation
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
Cancer
13 hours ago |
not rated yet |
0
Research examines new methods for managing digestive health
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
Cancer
13 hours ago |
not rated yet |
1
New colonoscope provides ground-breaking view of colon
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer
May 18, 2013 |
5 / 5 (2) |
0
ASCO: combo antibody therapy effective for melanoma
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer
May 17, 2013 |
not rated yet |
0
Risk factors ID'd for poor cutaneous cell CA outcomes
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer
May 17, 2013 |
not rated yet |
0
|
Researchers identify a potential new risk for sleep apnea: Asthma
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
Study finds that sleep apnea and Alzheimer's are linked
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
Ginger compounds may be effective in treating asthma symptoms
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
Computational tool translates complex data into simplified 2-dimensional images
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
New theory on genesis of osteoarthritis comes with successful therapy in mice
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
'Gap' for HIV vaccine efforts after latest setback
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.