Wednesday, March 14, 2007

Momentum builds for use of aromatase inhibitors in estrogen positive breast cancer

A recently published clinical trial provides more reason to prefer the aromatase inhibitors to tamoxifen in the treatment of estrogen positive breast cancer.

There are currently three aromatase inhibitors (AIs) approved for breast cancer treatment in hormone positive breast cancer:

Anastrazole (Arimidex)
Letrozole (Femara)
Exemestane (Aromasin)

Here is a NCI website with an annotated bibliography of some of the major clinical trials involving these drugs. The role of AIs seems most clear in high risk patients (large tumors,positive lymph nodes,higher grade histological changes) while the more severe estrogen depletion side effects makes its putative superiority over tamoxifen less clear in those breast cancer patients with low risk of recurrence.

Probably more than any other internal medicine sub specialists, oncologists have been obliged to plow through and attempt to master the deluge of clinical trials and try and determine how to translate those studies into the real life, day to day, medical management of patients with cancer. Two months ago, I had the opportunity to attend a 2 hour seminar on treatment of breast cancer given by a local private practice oncologist and by a local academic oncologists. The mastery of the trial data and their advice regarding practical application to treatment decisions that these two physicians demonstrated reminded me of one of the reasons that some of us went into internal medicine -the pleasure and sense of accomplishment of mastery (or as close as one can come to that with the moving target of medical advances and the accumulation of data contradicting older data) of complicated ideas and multiple facts and putting it all together into the care of sick patients.

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