Challenges in clinical patient management.
The use of endocrine therapy in breast cancer represents one of the earliest molecular targeting strategies used in cancer treatment. Tamoxifen, a selective estrogen-receptor (ER) modulator, has been the standard of care for women with receptor-positive breast cancer for the last 30 years. Tamoxifen suppresses the estrogen-dependent growth of breast cancer cells by specifically targeting the ER. Because of estrogenic effects, tamoxifen does not increase the risk of osteoporosis, but it can lead to endometrial cancer and thromboembolism. The third-generation aromatase inhibitors (AIs) exert their tumor antiproliferative action by targeting an enzyme critical for estrogen biosynthesis. The AIs thus have a different mechanism of action than tamoxifen, and a different safety profile. The majority of adverse events (AEs) related to the AIs are mild to moderate. Most of these AEs are common to menopause and are predictable and manageable. This review looks at AI-associated side effects and current clinical management strategies, with a particular emphasis on managing bone health. Compliance with long-term therapy, strategies to improve adherence, and considerations in elderly patients with hormone-responsive breast cancer are also discussed.
Aapro
Matti S
MS
IMO Clinique De Genolier, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland. maapro@genolier.net
D047072:Aromatase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D055118:Medication Adherence; D010024:Osteoporosis / Q000517:prevention & control; D000068296:Risedronic Acid; D013629:Tamoxifen / Q000627:therapeutic use
D047072:Aromatase Inhibitors; D004164:Diphosphonates; D013629:Tamoxifen; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid