The what, why and how of aromatase inhibitors: hormonal agents for treatment and prevention of breast cancer.
The third-generation aromatase inhibitors (AIs) anastrozole, exemestane and letrozole have largely replaced tamoxifen as the preferred treatment for hormone receptor - positive breast cancer in postmenopausal women. Approximately 185,000 new cases of invasive breast cancer are diagnosed yearly, and at least half of these women are both postmenopausal and eligible for adjuvant therapy with AIs. In addition, AIs are currently being tested as primary prevention therapy in large randomised trials involving tens of thousands of women at increased risk for breast cancer. Given the volume of use, internists will increasingly see postmenopausal women who are taking or considering treatment with AIs. Physicians need to be able to: (i) briefly discuss the pros and cons of using a selective estrogen receptor modulator such as tamoxifen or raloxifene vs. an AI for risk reduction and (ii) recognise and manage AI-associated adverse events. The primary purpose of this review is to help internists with these two tasks.
Fabian
C J
CJ
Breast Cancer Prevention Center, Division of Clinical Oncology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160-7418, USA. cfabian@kumc.edu
D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000139:chemically induced; D017024:Chemotherapy, Adjuvant; D004351:Drug Resistance; D005260:Female; D006801:Humans; D000077289:Letrozole; D009140:Musculoskeletal Diseases / Q000139:chemically induced; D009570:Nitriles / Q000627:therapeutic use; D017698:Postmenopause; D017697:Premenopause; D013629:Tamoxifen / Q000627:therapeutic use; D013923:Thromboembolism / Q000139:chemically induced; D014230:Triazoles / Q000627:therapeutic use
D000730:Androstadienes; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane