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Hormone Drug Type Makes Survival Difference in Advanced Breast Cancer

rogestins. Tamoxifen is the most widely used hormonal treatment in advanced breast cancer; however, it carries a risk of blood clots and other rare but potentially serious side effects.

Bliss said that the review found very little reliable data in the trials comparing the effectiveness of the different available aromatase inhibitors. “The promotion of one individual drug over another is not evidence-based and should be avoided,” the authors said.

In general, women taking aromatase inhibitors had about the same risk of experiencing hot flashes as those receiving tamoxifen. However, they reported more nausea, vomiting and diarrhea when compared to patients receiving the progestin drug megestrol acetate and to a lesser extent, when compared with patients receiving tamoxifen.

Patients taking aromatase inhibitors had a decreased risk of vaginal bleeding and blood clots compared to those using other hormonal therapies.

Safety data were difficult to analyze, Bliss said: “The picture is patchy due to poor quality of adverse event reporting and different study endpoints,” in the various trials.

However, “the review findings do confirm modest, but real therapeutic benefits from the use of aromatase inhibitors in a variety of clinical settings,” Bliss said.

Edith Perez, M.D., an oncologist with the Multidisciplinary Breast Cancer Program at the Mayo Clinic in Jacksonville, Fla., said, “The results of the review are not a surprise. These are good drugs and they have positively impacted the lives of patients with breast cancer.” Perez is not associated with the review.

Perez believes that aromatase inhibitors are the first drug of choice for hormonal treatment of advanced breast cancer in postmenopausal women. “They have a slightly improved efficacy over tamoxifen, and they have a much lower rate of blood clots in the legs and lungs,” she said. “Aromatase inhibitors carry almost no risk of uter
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