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Experts Discuss Role of AIs in Pre/Postmenopausal Patients

Experts Discuss Role of AIs in Pre/Postmenopausal Patients

CHICAGO--Aromatase inhibitors
(AIs) have an unquestioned role to play
in the treatment of postmenopausal
women with breast cancer, but there is
no single best approach for their use in
all patients, Eric Winer, MD, said at the
8th Annual Lynn Sage Breast Cancer symposium. In a separate meeting presentation,
Nancy Davidson, MD, cautioned
physicians about the use of AIs in premenopausal
women with hormone-receptor-
positive breast cancer and
chemotherapy-induced amenorrhea.

It's not possible to provide a "simple
answer" to the question of the best approach
for use of AIs in women with heterogeneous breast tumors, said Dr.
Winer, director of the Breast Oncology
Center and associate professor of medicine,
Harvard Medical School.

The optimal strategy for incorporating
AIs into the adjuvant treatment of
postmenopausal women with breast cancer
has not been defined, Dr. Winer said.
When given as initial therapy, AIs have
improved disease-free survival but not
overall survival. When given as part of a
crossover clinical trial design, the drugs
have increased both disease-free and overall
survival. However, follow-up of patients
treated with AIs has been limited.
Although therapy in excess of 10 years
may provide the most benefit, long-term
safety and efficacy data are lacking, he
commented.

Based on available data, Dr. Winer said
he believes that AIs should be used in the
treatment of postmenopausal women
with breast cancer, but given the heterogeneous
nature of breast tumors and the
types of patients in this population, he
suspects that there will not be a single
overall governing strategy for administering
the drugs.

Safety in Premenopausal Women
In her presentation on ovarian suppression/
ablation in premenopausal
breast cancer patients, Dr. Davidson
stressed that tamoxifen is the standard of
care for these women, that ovarian suppression/
ablation by surgery or LHRH
agonists might be used in addition and is
being studied, and that AIs are investigational
in these women.

Dr. Davidson, professor of oncology
and director of the Breast Cancer Research
Program, The Sidney Kimmel
Comprehensive Cancer Center, Johns
Hopkins University, pointed out that the
amenorrhea caused by cytotoxic therapy
is "not the same as menopause, and clinicians
should think hard about the safety
of AIs for such patients."

She presented findings from a "sobering"
case report involving the use of AIs
in 45 women with chemotherapy-induced
amenorrhea (J Clin Oncol 24:2444-
2447, 2006). The patients had a median
age of 47 years and varied experience with
AIs: 16 women received an AI as initial
therapy, 20 were later switched to an AI,
and 9 had extended AI therapy.

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