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March 16, 2005
News this month Results from several extensive five-year studies of postmenopausal women with hormone-sensitive breast cancer give new promise to a category of drugs called aromatase inhibitors. Anastrozole (brand name Arimidex), an aromatase inhibitor, was found to be better than tamoxifen when given to postmenopausal women with localized breast cancer. Results of the ATAC study (Arimidex, Tamoxifen Alone or in Combination), along with several European-based studies, were shared at the San Antonio Breast Cancer Symposium last December, one of the most important annual conferences on breast cancer. Studies found that aromatase inhibitors were more effective in keeping women with postmenopausal breast cancer disease-free longer than with tamoxifen alone.
Aromatase inhibitor more effective than tamoxifen “Aromatase inhibitors are arguably the biggest advance in breast cancer over the past 10 years and likely to reduce mortality yet further,” said Ian Smith of London's Royal Marsden Hospital, at the symposium. In the ATAC study, more than 9,300 postmenopausal women with localized breast cancer who had surgery participated. The women were divided into three groups: one-third took tamoxifen; one-third took anastrozole (aromatase inhibitor); and one-third took both drugs. The women were watched for more than five years. Increase in disease-free rates Anthony Howell, a professor from the University of Manchester, England, who co-wrote the study, reported the five-year ATAC results, sharing data culled from 9,366 patients at 381 centers in 21 countries. Raimund Jakesz from the Vienna Medical School reported on the combined results of two European trials, which together included 3,123 patients. Of these, 1,560 were treated with tamoxifen for five years and 1,563 were switched to anastrozole after an initial two years on taxoxifen. After 28 months of follow-up, the group treated with tamoxifen and then anastrozole had a longer disease-free survival compared with the group that remained on tamoxifen for five years. Aromatase inhibitors shut down estrogen The studies showed, however, an increase in the rate of bone fractures in patients receiving anastrozole, but a decrease in the side effects normally associated with tamoxifen treatment, including vaginal bleeding and discharge. Researchers concluded by saying, “Fully exploiting aromatase inhibition
will likely be a cornerstone of reducing breast cancer morbidity and mortality
in the future.”
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Yale-New Haven was recognized this year by U.S. News & World Report for its cancer services. |
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 Alone or with tamoxifen, aromatase inhibitors curtail recurrence and spread of breast cancer There has been a lot of talk in the news recently about a drug that might be more effective than the popular tamoxifen in treating postmenopausal breast cancer patients whose cancer is estrogen-related. “It is a wonderful new therapy
that gives doctors yet another tool in a growing arsenal of treatments.”
While I don't think aromatase inhibitors will replace tamoxifen altogether, it is a wonderful new therapy that gives doctors yet another tool in a growing arsenal of treatments. The news is especially good because aromatase inhibitors can supplement tamoxifen and fight hormone-receptor positive breast cancer from another angle. Aromatase inhibitors also do not seem to have the same degree of certain side effects as tamoxifen, most significantly, increased risk of uterine cancer, blood clotting and strokes. Three types of drugs In about 50 to 70 percent of breast cancer cases, the tumor is hormone-receptor positive, which means that the cancer cells are fueled by the hormones estrogen and progesterone. These hormones bind to the receptors on the cancer cells and help the tumor grow. Women with this type of cancer have typically been treated with tamoxifen for five years after their surgery. Aromatase inhibitors block an estrogen enzyme The use of aromatase inhibitors has now been well studied in many clinical trials throughout the world. Only now do we have five-year success rates that give us the confidence to say that this treatment may be more effective than tamoxifen. In the U.S. ATAC study (Arimidex, Tamoxifen Alone or in Combination), women with nonmetastatic hormone-sensitive breast cancer were divided into three groups.
The study found that anastrozole was superior to tamoxifen in preventing relapse. The combination of the two drugs had the worst outcome, probably because the drugs were toxic or antagonistic together. “More research is needed to determine if an aromatase inhibitor can ultimately save more lives.”
The study found that anastrozole was more effective than tamoxifen in increasing the number of women who remained cancer-free, lengthening the time before recurrence and reducing the incidence of cancer in the other breast. The study didn't show better overall survival rates for women taking an aromatase inhibitor. More research is needed to determine if an aromatase inhibitor can ultimately save more lives. Can be used in sequence with tamoxifen I don't think that aromatase inhibitors will replace tamoxifen altogether, but rather, can be used perhaps in sequence with tamoxifen as seen in the European studies. Tamoxifen can still be quite effective in the metastatic setting (spread beyond the breast or lymph nodes) and also after patients' tumors become resistant to aromatase inhibitors and vice versa. More research underway Side effects What this all means is that doctors don't have to be wedded
to one type of drug to treat postmenopausal women with estrogen-sensitive
breast cancer. We have another new resource to treat women in addition
to tamoxifen, and patients can move to an aromatase inhibitor even
after they've started with tamoxifen. Gina Chung, MD, is an attending oncologist at Yale-New Haven Hospital and assistant professor of medical oncology at Yale University School of Medicine. |
