More on Aromatase Inhibitors and Tamoxifen: Highlights from a Brand New Breast Cancer Symposium

PJ Hamel Health Guide
  • The American Society of Clinical Oncology (ASCO), over 25,000 members strong, includes representatives from all areas of cancer care: oncologists, oncological radiologists and surgeons, oncology nurses, and other practitioners whose main focus is cancer care. Billed on its Web site as “the world’s leading professional organization representing physicians who treat people with cancer,” this non-profit organization of cancer professionals is over 40 years old, with a stated goal of “improving cancer care and prevention and ensuring that all patients with cancer receive care of the highest quality.” I LIKE this group.
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    ASCO was the chief sponsor, along with five other professional groups, of a first-time breast cancer symposium, Sept. 7-8 in San Francisco. Oncologists attended seminars detailing the latest and greatest breast cancer treatments and research breakthroughs, and also had the opportunity to network–which, if you’ve ever attended a professional conference, you know is where most of the vital information is actually exchanged. Here are a few general interest highlights from that first breast cancer symposium:

    •There’s new evidence that aromatase inhibitors (AI) work. Femara, Arimidex, and Aromasin have been gradually replacing tamoxifen as the post-treatment hormonal drug of choice for postmenopausal women with ER-positive breast cancer. Results of an admittedly small and preliminary study showed that AIs decreased the presence of gene markers related not only to recurrent cancer; but to new cancer in the other (unaffected) breast.

    Nancy E. Davidson, M.D., ASCO’s president, called the results “provocative.” She also noted that being able to see a direct correlation between AIs, and a drop in gene markers, allows doctors to track their effectiveness more closely. Rather than undertaking trials that involve thousands of women and many years, researchers can see a real-time decrease in those gene markers that signal the very early possible presence of cancer.

    • Speaking of AIs, another report at the symposium noted that “the aches and pains associated with aromatase inhibitors may be more important than previously believed.” In a study comparing the relative effectiveness of two different AIs, a full 13% of participants left the study because they quit taking the drugs due to pain–a much higher dropout rate than anticipated. The three most common complaints? Rotator cuff tendonitis; carpal tunnel syndrome; and osteoarthritis. For those of you on AIs and experiencing pain, it’s not in your head. You’re not a wimp. It’s real. You have a choice to make: endure the pain for the protection against recurrence it gives you… or don’t?

    • Why do black women with breast cancer have poorer outcomes than white women? This question has plagued researchers and been in the news for several years now. While access to treatment, education, and income have all been put forth as reasons, it appears biology may be another significant culprit. African-American women are more likely than white women to be diagnosed with ER-negative breast cancer. And that’s not good; ER-negative cancer is more aggressive; less responsive to treatment, AND there are fewer treatment options. Black women of all ages are more likely than white women to experience this inherently more deadly cancer; and this leads to poorer overall outcomes.

  • • Think twice about skipping your daily tamoxifen: a new Scottish study showed that women who filled fewer than 70% of their tamoxifen prescriptions (10% of women in the study) had a 16% greater risk of dying than those who faithfully took their pill every day.
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    Over the years, tamoxifen has been a real superstar in the constellation of cancer-fighting drugs for postmenopausal women with ER-positive breast cancer. Though aromatase inhibitors are gradually replacing tamoxifen as the new drug of choice, their side effects are more immediately severe; 42% of women taking AIs report significant pain in either joints or muscles. And those bothersome side effects may make AIs even tougher to take, meaning a decade or so from now we may be reading that women who didn’t stay the course with AIs have had a higher mortality rate. “As we move toward the aromatase inhibitors… it might be even more important not to skip a couple of days,” noted Dr. Julie Gralow of the University of Washington in Seattle, who moderated the press conference at which the study information was released. No pain, no gain? Would that it weren’t so…
Published On: September 24, 2007