scholarly journals Anastrozole Use in Early Stage Breast Cancer of Post-Menopausal Women

2009 ◽  
Vol 1 ◽  
pp. CMT.S9 ◽  
Author(s):  
Monica Milani ◽  
Gautam Jha ◽  
David A. Potter
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Estrogen Receptor ◽  
Hormone Receptor ◽  
Early Stage ◽  
Breast Cancers ◽  
Adjuvant Setting ◽  
Hormone Receptor Positive ◽  
Menopausal Women ◽  
Post Menopausal

The majority of breast cancers express the estrogen receptor and depend on estradiol (E2) for their growth. Hormonal therapy aims at depriving estrogen signaling either by using selective estrogen receptor modulators (SERM)–-that interfere with the binding of E2 to its receptor (ER)–-or aromatase inhibitors (AI)–-that block the aromatase-dependent synthesis of E2. While SERMs are recommended for both pre- and post-menopausal patients, AIs are indicated only for post-menopausal patients. For the past 20 years, the SERM tamoxifen has been considered the “gold standard” for the treatment of hormone receptor positive breast cancers. However, tamoxifen's role is now challenged by third generation AIs, such as anastrozole, which exhibit greater efficacy in the adjuvant setting in several recently reported trials. This review will focus on anastrozole's mechanism of action, dosing, pharmacology, pharmacokinetics, and clinical applications. It will briefly discuss the clinical trials that determined anastrozole's efficacy in the treatment of advanced breast cancer (ABC) and in the neo-adjuvant setting. Finally, it will present the clinical trials that established anastrozole as a frontline agent in the treatment of post-menopausal women with hormone receptor positive early breast cancer.

scholarly journals Endocrine Therapy in Premenopausal Hormone Receptor–Positive Breast Cancer

2016 ◽  
Vol 12 (11) ◽  
pp. 1148-1156 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
Kari B. Wisinski ◽  
Ruth M. O’Regan
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Systemic Therapy ◽  
Hormone Receptor ◽  
Randomized Trials ◽  
Early Stage ◽  
Premenopausal Women ◽  
Breast Cancers ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

Systemic therapy for premenopausal women with hormone receptor–positive breast cancer has evolved in the last 5 years, but critical questions remain. Recent randomized trials have demonstrated a benefit for the addition of ovarian suppression to endocrine therapy in patients with breast cancers considered to be at high risk for recurrence, whereas those with lower-risk cancers seem to have a favorable outcome with tamoxifen alone. Two large randomized trials have demonstrated a benefit for extending adjuvant tamoxifen beyond 5 years. Currently the choice of systemic therapy is selected empirically but molecular profiling may, in the near future, provide a more conclusive means of selecting an endocrine therapeutic approach for premenopausal patients. Given that a significant subset of hormone receptor–positive cancers are intrinsically resistant to endocrine agents, as well as the finding that inhibiting cyclin-dependent kinases 4 and 6 and mammalian target of rapamycin appears to potentially reverse this resistance in patients with metastatic disease, evaluation of these agents in the early-stage setting is ongoing.

Hormonal Therapy for the Treatment of Postmenopausal Breast Cancer Patients

2008 ◽  
Vol 21 (1) ◽  
pp. 36-45
Author(s):  
Rebecca E. Greene ◽  
Vivian Tsang
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Postmenopausal Women ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Postmenopausal Breast Cancer ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Hormone Receptor Positive ◽  
Receptor Modulator

Breast cancer is the most common cancer diagnosed and the second leading cause of cancer-related death in women. The majority of breast cancers diagnosed in postmenopausal women are hormone receptor positive and involve therapy with hormonal agents. Tamoxifen, a selective estrogen-receptor modulator, has been the mainstay of hormonal therapy since the 1970s. The more recent approval and success of aromatase inhibitors, such as anastrozole, letrozole, and exemestane, have seen these agents move to the front line of therapy for postmenopausal women with hormone-positive breast cancer in the adjuvant and metastatic settings. Fulvestrant, a selective estrogen receptor— downregulator, provides an additional hormonal therapy with a novel mechanism of action. This article reviews the current literature available regarding the use of these agents for postmenopausal women with early stage or advanced breast cancer.

scholarly journals Problems with the Use of Aromatase Inhibitors in Breast Cancer

2018 ◽  
Vol 4 (1) ◽  
pp. 41-42
Author(s):  
James J Stark
Keyword(s):  
Breast Cancer ◽  
Aromatase Inhibitors ◽  
Hormone Receptor ◽  
Mineral Density ◽  
Dexa Scan ◽  
Hormone Receptor Positive ◽  
Menopausal Women ◽  
Post Menopausal ◽  
Oncology Practice ◽  
Medicare Database

The use of Aromatase Inhibitors (AI’s) in the adjuvant therapy of operable breast cancer is ubiquitous. All guidelines in widespread use advocate their use in hormone-receptor-positive breast cancer in post-menopausal women. Premenopausal hormone-receptor-positive women who are considered at high risk of relapse are also treated with drug- or surgically-induced ovarian suppression plus an AI following chemotherapy, producing somewhat better results than those seen with chemo followed by tamoxifen [1]. A major side effect of these drugs is the accelerated loss of bone mineral density (BMD). The use of bone-sparing agents such as bisphosphonates has become widespread but not routine in these patients. Whether or not they receive bone-sparing agents, patients on AI’s should receive periodic assessment of bone density. How do doctors comply with this common-sense approach? The answer: not as often as they should. The best data on this practice was published in the Journal of Oncology Practice in May 2017 from a group of investigators at Yale [2]. Using the SEER Medicare database they identified over 135,000 women diagnosed with breast cancer from 2007 to 2010. Using robust exclusion criteria for such things as metastasis at presentation, too brief exposure to bisphosphonates, in situ only cancer, and prior diagnosis of osteoporosis, they identified 2409 women who met all entry criteria and served as the population studied. Within this group only 51% received a DEXA scan at initiation of AI and only 34% had a second scan within three years of being on therapy. What the authors were not able to ascertain was how many of these patients were placed on a prophylactic bisphosphonate or equivalent at the start of AI therapy. What was clear is that age and race had a lot to do with who received a DEXA scan. 30% of women over 85 vs. 56% ages 67-69 were scanned. 53% of causasian women were scanned vs. 33% non-caucasian. Wonen with higher stage and more comorbidities were also less likely to have been scanned.

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