Managing the toxicities of the aromatase inhibitors.
OBJECTIVE
The aromatase inhibitors are increasingly used as adjuvant therapy in postmenopausal women with hormone receptor positive breast cancer. With additional experience using these agents, unanticipated side effects have become apparent. Women who experience side effects from adjuvant endocrine therapy are the individuals who derive the greatest benefits. Because noncompliance is highest among those who experience side effects, it is important that these symptoms be palliated.


RESULTS
The symptomatic effects of aromatase inhibitors include: hot flashes, arthralgias, vaginal dryness and dyspareunia. Hot flashes may successfully be treated with either serotonin reuptake inhibitors or gabapentin. Counseling, vaginal moisturizers and lubricants can improve symptoms related to sexual functioning. The mechanism of arthralgias is uncertain and anti-inflammatory agents are seldom effective. Patients who experience severe musculoskeletal discomfort may necessitate switching to another endocrine agent such as tamoxifen. Physicians should be aware of 'silent' side effects. Screening for bone loss and hypercholesterolemia is critical and patients should be treated accordingly.


CONCLUSIONS
Patients and physicians should openly discuss the short and long-term side effects of the aromatase inhibitors as many of these symptoms can be managed effectively. By optimizing quality of life on adjuvant endocrine therapy, noncompliance may be minimized.
Mortimer
Joanne E
JE
Dept. of Medical Oncology and Developmental Therapeutics, Affiliate Programs, City of Hope, Duarte, California 91010, USA. jmortimer@coh.org
D047072:Aromatase Inhibitors / Q000009:adverse effects*; D018771:Arthralgia / Q000139:chemically induced; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000188:drug therapy; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004414:Dyspareunia / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D019584:Hot Flashes / Q000139:chemically induced / Q000188:drug therapy; D006801:Humans; D055118:Medication Adherence
D047072:Aromatase Inhibitors