aromatase inhibitor
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Indications
- treatment of estrogen receptor-positive status breast cancer in postmenopausal women
- aromatase inhibitors lower breast cancer recurrence in postmenopausal women relative to tamoxifen by 30%[8]
- aromatase inhibitors lower breast cancer mortality in postmenopausal women relative to tamoxifen[8]
- treatment of ovarian cancer[2]
Contraindications
Adverse effects
- see specific aromatase inhibitor
- osteoporosis resulting in pathologic fracture[1]
- evaluated fracture risk in all women starting aromatase inhibitor[10]
- bisphosphate or other therapy for women with T-score <-2.0 SD, T-score < -1.5 SD + 1 other fracture risk factor (i.e. age >65 or low body-mass index) or > 1 risk factor.
- zoledronate yearly or denosumab every 6 months[4][10]
- oral bisphosphonate may be less effective[10]
- joint pain, musculoskeletal pain (arthralgias & myalgias)[5] may be caused by diminished estrogen levels; estrogen is thought to have anti-inflammatory properties & to inhibit pain signals
- clinically significant musculoskeletal complications develop in ~50% of women treated with aromatase inhibitors[11]
- development of musculoskeletal pain & arthragias during treatment is linked to better breast cancer outcomes[11]
- a 2nd aromatase inhibitor should be tried if patient develops severe musculoskeletal symptoms[1]
- duloxetine & exercise may be of benefit[1]
- if musculoskeletal symptoms persist, tamoxifen should be tried[1]
- acupuncture 2 sesson/week for 6 weeks of benefit[12]
- vaginal dryness (20%)[2]
- safety of vaginal estrogens not known
- systemic absorption occurs with use of vaginal estrogens
- tends to decrease as therapy continues
- absorption highes with creams, lowest with Estrig
- vaginal lubricants (Astroglide, Replens, Lubrin) safer than vaginal estrogens
- ovarian stimulation in premenopausal women
- fatigue, anxiety, depression
- acupuncture may be of some benefit[7]
- ESR1 gene mutations confer resistance to aromatase inhibitors
Radiology
- serial bone mineral density every other year[1]
More general terms
More specific terms
- anastrozole (Arimidex)
- exemestane (Aromasin)
- letrozole (Femara)
- metandroden (Atamestane)
- testolactone (Teslac, Fludestrin)
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19. American College of Physicians, Philadelphia 2012, 2015, 2019
- ↑ 2.0 2.1 2.2 Prescriber's Letter 13(5): 2006 Aromatase inhibitors and vaginal estrogen Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220516&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Becker T, Lipscombe L, Narod S, et al. Systematic review of bone health in older women treated with aromatase inhibitors for early-stage breast cancer. J Am Geriatr Soc. 2012 Sep;60(9):1761-1767. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22985145
- ↑ 4.0 4.1 Coleman R, de Boer R, Eidtmann H et al Zoledronic acid (zoledronate) for postmenopausal women with early breast cancer receiving adjuvant letrozole (ZO-FAST study): final 60-month results. Ann Oncol. 2013 Feb;24(2):398-405. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23047045
Llombart A, Frassoldati A, Paija O, Immediate Administration of Zoledronic Acid Reduces Aromatase Inhibitor-Associated Bone Loss in Postmenopausal Women With Early Breast Cancer: 12-month analysis of the E-ZO-FAST trial. Clin Breast Cancer. 2012 Feb;12(1):40-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22014381 - ↑ 5.0 5.1 Prescriber's Letter 12(9): 2005 Aromatase inhibitors & the Risk of Arthralgias Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211019&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Deprecated Reference
- ↑ 7.0 7.1 Mao JJ et al Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor- related arthralgia: A randomized trial. Cancer. Online July 30, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25077452 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/cncr.28917/abstract
- ↑ 8.0 8.1 8.2 Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet. Published Online: 23 July 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26211827 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961074-1/abstract
Mayer EL, Burstein HJ Postmenopausal breast cancer: a best endocrine strategy? Lancet. Published Online: 23 July 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26211823 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961206-5/abstract - ↑ Henry NL, Azzouz F, Desta Z et al Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J Clin Oncol. 2012 Mar 20;30(9):936-42 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22331951
- ↑ 10.0 10.1 10.2 10.3 Hadji P, Aaprob MS, Body JJ et al Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG. J Bone Oncol. 2017 Mar 23;7:1-12. eCollection 2017 Jun. Review <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28413771 Free PMC Article <Internet> http://www.sciencedirect.com/science/article/pii/S2212137417300258
International Osteoporosis Foundation Public Release: 25-Apr-2017 New guidance for management of aromatase-inhibitor related bone loss in breast cancer. https://www.eurekalert.org/pub_releases/2017-04/iof-ngf042517.php - ↑ 11.0 11.1 11.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
Tenti S, Correale P, Cheleschi S, et al. Aromatase inhibitors-induced musculoskeletal disorders: current knowledge on clinical and molecular aspects. Int J Mol Sci. 2020;21(16):5625 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32781535 PMCID: PMC7460580 Free PMC article https://www.mdpi.com/1422-0067/21/16/5625 - ↑ 12.0 12.1 Hershman DL, Unger JM, Greenlee H et al Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor-Related Joint Pain. A Randomized Clinical Trial. JAMA Netw Open. 2022;5(11):e2241720 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798317
- ↑ 13.0 13.1 Tan WW, Marienberg ES Fast Five Quiz: Precision Medicine in Cancer Medscape. January 06, 2023 https://reference.medscape.com/viewarticle/954083