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Senior Citizen Health & Medicine
Aromatase Inhibitor Hormone Drugs Make Survival
Difference in Advanced Breast Cancer
Review of studies of 10,000 older women say it
is better for patients
By Katherine Kahn, Contributing Writer
Health Behavior News Service
 January 30, 2007 - Aromatase inhibitors, a type of
hormone therapy used to treat advanced breast cancer in postmenopausal
women, result in a small but significant increase in overall survival
when compared to other hormone treatments, according to a new systematic
review of studies.
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In addition, aromatase inhibitors drugs known as
Arimidex, Aromasin and Femara are less likely to cause blood clots and
vaginal bleeding than other hormone treatments, said review co-author
Judith Bliss of the Institute of Cancer Research in London.
The review analyzed 30 studies involving the
treatment of advanced breast cancer, encompassing more than 10,000
postmenopausal women.
Bliss and colleagues were surprised at how few of
the reviewed studies presented data on overall survival for women taking
aromatase inhibitors. Survival data was only available for about half
of the women, Bliss said.
The available data showed an 11 percent reduction
in the risk of death compared to women not receiving aromatase
inhibitors.
The review appears in the current issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
The treatment of advanced breast cancer in women
who have gone through menopause usually involves a combination of
surgery, radiation, chemotherapy, hormonal and biological therapies. In
many breast cancers, estrogen stimulates tumor growth. Aromatase
inhibitors work by limiting a womans production of estrogen.
Several aromatase inhibitors, including anastrozole
(Arimidex), exemestane (Aromasin) and letrozole (Femara) have been
available for clinical use for the past decade or so.
Other breast cancer treatments that also affect
estrogen include tamoxifen and progestins. Tamoxifen is the most widely
used hormonal treatment in advanced breast cancer; however, it carries a
risk of blood clots and other rare but potentially serious side effects.
Bliss said that the review found very little
reliable data in the trials comparing the effectiveness of the different
available aromatase inhibitors. The promotion of one individual drug
over another is not evidence-based and should be avoided, the authors
said.
In general, women taking aromatase inhibitors had
about the same risk of experiencing hot flashes as those receiving
tamoxifen. However, they reported more nausea, vomiting and diarrhea
when compared to patients receiving the progestin drug megestrol acetate
and to a lesser extent, when compared with patients receiving tamoxifen.
Patients taking aromatase inhibitors had a
decreased risk of vaginal bleeding and blood clots compared to those
using other hormonal therapies.
Safety data were difficult to analyze, Bliss said:
The picture is patchy due to poor quality of adverse event reporting
and different study endpoints, in the various trials.
However, the review findings do confirm modest,
but real therapeutic benefits from the use of aromatase inhibitors in a
variety of clinical settings, Bliss said.
Edith Perez, M.D., an oncologist with the
Multidisciplinary Breast Cancer Program at the Mayo Clinic in
Jacksonville, Fla., said, The results of the review are not a surprise.
These are good drugs and they have positively impacted the lives of
patients with breast cancer. Perez is not associated with the review.
Perez believes that aromatase inhibitors are the
first drug of choice for hormonal treatment of advanced breast cancer in
postmenopausal women. They have a slightly improved efficacy over
tamoxifen, and they have a much lower rate of blood clots in the legs
and lungs, she said. Aromatase inhibitors carry almost no risk of
uterine cancer, and while that rarely happens with tamoxifen, it does
happen.
On the other hand, Perez said that aromatase
inhibitors do carry a risk of increased joint aches and, more
importantly, may cause bone loss. The majority of patients do very well
but we recommend patients have bone density tests before using these
drugs. I would probably not use aromatase inhibitors in a patient with
severe osteoporosis.
While per-tablet cost of aromatase inhibitors is
higher than tamoxifen, Perez said that they are still cost-effective
because they have fewer side effects requiring treatment and they result
in increased overall survival.
Its no question that these drugs are better for
patients when compared with other hormone therapies, Perez said.
Editor's Notes:
Source: Gibson LJ, Dawson, CL, Lawrence DJ, Bliss
JM. Aromatase inhibitors for treatment of advanced breast cancer in
postmenopausal women (Review). Cochrane Database of Systematic Reviews
2007, Issue 1.
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit
http://www.cochrane.org for more information.
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