Archive for the ‘Aromatase Inhibitor’ Category

From the Physician’s Desk … Weekly Blog! 


Greetings! Now that you are aware of the meaning of “Adjuvant” *smile* let us review a recent article from the New England Journal of Medicine (NEJM) on 1 JUN 2014 and some other recent changes for Breast Cancer treatments (not to worry! I will also cover other types of Cancers as information becomes available;).

In the diagnosis of breast cancer, the receptor status is very important (please review blog here on receptor status).  If, the Estrogen Receptor (ER) and/or the Progesterone Receptor (PR) are positive, then a medication in pill form (Endocrine/Hormone Therapy) is usually given for 5-10 years. Depriving ER-positive breast cancers of estrogen can slow their growth. Tamoxifen is an anti-estrogen that has long been a mainstay of hormonal (or endocrine) therapy for breast cancer.

The type of medication given in the adjuvant setting (after surgery and/or Radiation Therapy) to women who are still having monthly menstrual cycle (Pre-menopausal) is different from the medication given to those who are no longer have menstrual cycles (Post-menopausal – or as my elders refer to it as, having “gone through the change of life!” ).  A previous study showed that an AI decrease recurrence risk more than Tamoxifen in post-menopausal women and so AIs are commonly used in the post-menopausal setting.

breastIn general terms, the study question was – Can we decrease the recurrence risk for pre-menopausal women as we did for post-menopausal women with the use of an AI? If we made patients who are still having menstrual cycle become “post-menopausal” would their outcome also improve with an AI ? The study concluded that;

“…for premenopausal women with hormone-receptor-positive breast cancer, adjuvant treatment with ovarian suppression plus and aromatase inhibitor (AI) Exemestane … [as compared with ovarian suppression plus tamoxifen] … provides a new treatment option that reduces the risk of recurrence. Premenopausal women who receive ovarian suppression may now benefit from an AI, a class of drugs that until now has been recommended only for post-menopausal women.”        June 1, 2014 at the 2014 American Society of Clinical Oncology Annual Meeting and published online on the same day by the New England Journal of Medicine.

Read more about this study by clicking HERE

In essence, if you are diagnosed with estrogen receptor positive (ER+) Breast Cancer at a young age, that is, while still experiencing monthly menstrual cycle, a NEW option of AI plus ovarian suppression can reduce your risk of breast cancer coming back…the “suggestion” is that AI in this setting may be better than Tamoxifen.  Toxicity may be an issue for some patients, so should be taken into consideration. This is definitely worthy discussion with your Medical Oncologist to decide which option is best for you (or individual patient)!

So for pre-menopausal women in the adjuvant setting:

Tamoxifen OR

Ovarian Suppression plus Tamoxifen    OR

Ovarian Suppression plus Exemestane (AI) OR




breast pink



Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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