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Review
. 2007;105 Suppl 1(Suppl 1):75-89.
doi: 10.1007/s10549-007-9704-7. Epub 2007 Oct 3.

Safety of aromatase inhibitors in the adjuvant setting

Edith A Perez  1
Affiliations
Review

Safety of aromatase inhibitors in the adjuvant setting

Edith A Perez. Breast Cancer Res Treat. 2007.

Erratum in

  • Breast Cancer Res Treat. 2008 Nov;112(2):379

Abstract

The third-generation aromatase inhibitors (AIs) letrozole, anastrozole, and exemestane are replacing tamoxifen as adjuvant therapy in most postmenopausal women with early breast cancer. Although AIs have demonstrated superior efficacy and better overall safety compared with tamoxifen in randomized controlled trials, they may not provide the cardioprotective effects of tamoxifen, and bone loss may be a concern with their long-term adjuvant use. Patients require regular bone mineral density monitoring, and prophylactic bisphosphonates are being evaluated to determine whether they may protect long-term bone health. AIs decrease the risks of thromboembolic and cerebrovascular events compared with tamoxifen, and the overall rate of cardiovascular events in patients treated with AIs is within the range seen in age-matched, non-breast-cancer populations. AIs are also associated with a lower incidence of endometrial cancer and fewer vaginal bleeding/discharge events than tamoxifen. Compared with tamoxifen, the incidence of hot flashes is lower with anastrozole and letrozole but may be higher with exemestane. Generally, adverse events with AIs are predictable and manageable, whereas tamoxifen may be associated with life-threatening events in a minority of patients. Overall, the benefits of AIs over tamoxifen are achieved without compromising overall quality of life.

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Figures

Fig. 1
Fig. 1
Age-standardized fracture incident rates by survivor status. Standardized rates were calculated using the age distribution of the entire Women’s Health Initiative Observational Study cohort. Excess numbers of fractures per 10,000 person-years are above each set of bars [35]. ©2005 American Medical Association. Reproduced with permission
Fig. 2
Fig. 2
Mean change score in Short Form 36-item Health Survey. A positive score indicates a favorable change in quality of life. (A) Physical component summary; P = not significant for all time points. (B) Mental component summary; P = not significant for all time points. [133]. ©2005 American Society of Clinical Oncology. Reproduced with permission
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