title: Aromatase inhibitors in post-menopausal metastatic breast carcinoma.
abstract: To summarise the advances in the hormonal treatment of post-menopausal metastatic breast cancer, this paper reviews the published literature regarding the randomised trials comparing aromatase inhibitors (AIs) versus tamoxifen as a first-line therapeutic choice, or AIs versus megestrole acetate (MEG) as a second-line option. The pooled analysis of these authors on AI versus MEG as a second-line option for post-menopausal metastatic breast cancer suggested that AIs do not add any significant benefit over MEG in terms of overall response rate (ORR) and time to progression. According to the Cochrane Database, use of an AI as a second-line therapy versus any other endocrine therapy (mostly MEG) has shown a significant benefit in terms of overall survival, but not for progression-free survival, clinical benefit (CB) or ORR. Concerning the authors' comparisons between AIs versus tamoxifen as a first-line endocrine option in post-menopausal women with metastatic breast carcinoma, AIs seem to be superior to tamoxifen, with a significant benefit in terms of ORR, CB and time to progression being observed in favour of AIs over tamoxifen with fixed effects estimates. According to the Cochrane Database, there was an advantage to the use of AIs over tamoxifen in terms of progression-free survival and CB, but not for overall survival or ORR. With regards to toxicity, AIs show similar levels of hot flushes and arthralgia, increased risks of nausea, diarrhoea and vomiting, but a decreased risk of vaginal bleeding and thromboembolic events compared with other endocrine therapies. Weight gain, dyspnoea and peripheral oedema seem to be more frequent with MEG. At present, there is no proved overall survival difference in patients who are treated first with an AI and then with tamoxifen compared with the opposite sequence. In the metastatic setting, results are limited and are based on retrospective analyses.
authors.affiliation: Regina Elena Cancer Institute, Division of Medical Oncology A, Rome, Italy. paolo_carlini@yahoo.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Carlini
authors.forename: Emilio
authors.initials: E
authors.lastname: Bria
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Felici
authors.forename: Paola
authors.initials: P
authors.lastname: Papaldo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
authors.forename: Enzo Maria
authors.initials: EM
authors.lastname: Ruggeri
authors.forename: Michele
authors.initials: M
authors.lastname: Milella
authors.forename: Carmen
authors.initials: C
authors.lastname: Nuzzo
authors.forename: Fabiana Letizia
authors.initials: FL
authors.lastname: Cecere
authors.forename: Alain
authors.initials: A
authors.lastname: Gelibter
authors.forename: Maria Simona
authors.initials: MS
authors.lastname: Pino
authors.forename: Cecilia
authors.initials: C
authors.lastname: Nisticò
authors.forename: Federica
authors.initials: F
authors.lastname: Cuppone
authors.forename: Giulio
authors.initials: G
authors.lastname: Metro
authors.forename: Edmondo
authors.initials: E
authors.lastname: Terzoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Cognetti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ferretti
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D047072:Aromatase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015507:Drugs, Investigational; D005260:Female; D006801:Humans; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D017698:Postmenopause; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D015507:Drugs, Investigational; D013629:Tamoxifen