title: Switching to letrozole or exemestane improves hot flushes, mood and quality of life in tamoxifen intolerant women.
abstract: We report an open-label, prospective, crossover study involving 184 post-menopausal women experiencing hot flushes on adjuvant tamoxifen (T). Six weeks after switching to an AI, the primary end point, hot flush score, improved by 47.3% (P<0.001) compared to those reported on T. The mean mood rating scale (MRS) score improved by 9.7% (P=0.01). The total mean combined FACT (b+es) score improved from 134.2 (95% CI +/-2.96) to 143.5 (95% CI +/-2.96 <0.001), and the endocrine subscale improved by 9.8% from 51.73 (95% CI +/-1.38) to 57.34 (CI +/-1.38, P<0.001). At 6 weeks, significantly more women chose to remain on an AI: 133 (72%), vs 40 (22%) (P<0.001) preferring T. At 3 months, 107 (58%) preferred to remain on an AI, 55(30%) on T, and 22 (12%) withdrew. The overall arthralgia rate at 3 months was 47% on AI and 30% on T (P=0.001). In all 182 (99%) women reported appreciating the opportunity to experience both drugs. These data suggest that if patients suffering significant adverse effects on T are given the opportunity to try an AI, this empowers them to prioritize relative side-effects, improving wellbeing in a significant proportion. These data also highlight the need for hospital follow-up in this intolerant cohort.
authors.affiliation: Primrose Oncology Research Unit, Bedford Hospital NHS Trust, Kempston Road, Bedford MK4 9DJ, UK. rt@cancernet.co.uk
authors.forename: R
authors.initials: R
authors.lastname: Thomas
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.forename: C
authors.initials: C
authors.lastname: Marshall
authors.forename: L
authors.initials: L
authors.lastname: Walker
mesh_terms: D000339:Affect / Q000187:drug effects; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D018771:Arthralgia / Q000139:chemically induced; D001943:Breast Neoplasms / Q000188:drug therapy; D017024:Chemotherapy, Adjuvant; D018592:Cross-Over Studies; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D019584:Hot Flashes / Q000139:chemically induced*; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage* / Q000009:adverse effects; D010358:Patient Participation; D018579:Patient Selection; D017698:Postmenopause; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D018401:Sample Size; D011795:Surveys and Questionnaires; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects*; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D020847:Estrogen Receptor Modulators; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077289:Letrozole; C056516:exemestane