Anastrozole (Arimidex) in clinical practice versus the old 'gold standard', tamoxifen

Cutaneous adverse effects of hormonal adjuvant therapy for breast cancer: a case of localised urticarial vasculitis following anastrozole therapy and a review of the literature

Hormonal therapy with either tamoxifen or aromatase inhibitors is commonly used to treat women with breast cancer in both the adjuvant and recurrent disease setting. Cutaneous adverse reactions to these drugs have been rarely reported in the literature. We report an unusual case of urticarial vasculitis following the aromatase inhibitor anastrozole that localised to the unilateral trunk and mastectomy scar, and review the literature on the cutaneous adverse effects of hormonal therapy for breast cancer.

Anastrozole for breast cancer: recent advances and ongoing challenges

Third-generation aromatase inhibitors are accepted widely as alternatives to tamoxifen for the treatment of advanced breast cancer in postmenopausal women and, currently, are increasingly replacing tamoxifen in the adjuvant setting. This drug profile focuses on recent clinical developments in the use of anastrozole and, in particular, on the Arimidex, Tamoxifen, Alone or in Combination trial, which has shown that initial adjuvant treatment with anastrozole has significant efficacy and tolerability advantages compared with tamoxifen for postmenopausal women with early breast cancer. Results of adjuvant switching, extended adjuvant and preoperative (neoadjuvant) studies are reviewed and the potential of anastrozole in a range of clinical settings is discussed. Treatment recommendations and the future role of anastrozole in the management of patients with early breast cancer are also considered.

3-Amino-1,2,4-triazolium ion in [24(3at)]Cl and [24(3at)]₂SnCl6·H₂O. Comparative X-ray, vibrational and theoretical studies

Crystal structures of 3-amino-1,2,4-triazolium chloride and bis(3-amino-1,2,4-triazolium) hexachloridostannate monohydrate were determined by means of X-ray single crystal diffraction. The route of protonation of organic molecule and tautomer equilibrium constants for the cationic forms were calculated using B3LYP/6-31G* method. The most stable protonated species is 2,4-H(2)-3-amino-1,2,4-triazolium ion, 24(3at)(+). Very good agreement between theoretical and experimental frequencies was achieved due to very weak interactions existing in studied compounds. Significantly weaker intermolecular interactions are found in [24(3at)](2)SnCl(6)·H(2)O than in [24(3at)]Cl. The differences in strength of interactions are manifested in red and blue shifts for stretching and bending motions, respectively. PED calculations show that for 24(3at)(+) ion the stretching type of motion of two N(ring)H bonds is independent, whereas bending is coupled.

Hormonal modulation in the treatment of breast cancer

This article explores the history of endocrine therapy for the treatment of breast cancer, the clinical evidence behind the current standards of care, and controversies that may change these standards in the future.

Initial treatment and changes in adjuvant endocrine therapy for early stage breast cancer

Clinical trials have shown that aromatase inhibitors (AIs) are an important advance in the treatment of early stage breast cancer (ESBC), but practice patterns and the impact of treatment side effects of endocrine therapy in the community setting have not been extensively explored. This retrospective chart review describes practice patterns among patients receiving adjuvant endocrine therapy for ESBC. Charts of 200 patients with confirmed stage I-IIIA breast cancer were reviewed. Patients received first-line treatment with tamoxifen (n=96) or AIs (n=104). Fifty-one patients completed a structured interview regarding symptom burden during therapy. Time to discontinuation or switching from first-line therapy did not vary by drug class (tamoxifen vs. AI). Musculoskeletal symptoms predicted time to switching among AI patients. Tamoxifen patients who switched to AIs tended to do so following clinical guidelines for use of AIs. Interview results showed that more anastrozole than tamoxifen patients cited side effects as the reason for switching.

Anastrozole therapy in recurrent ovarian adult granulosa cell tumors: A report of 2 cases

BACKGROUND

Ovarian sex cord stromal tumors are frequently hormonally active, and adult granulosa cell tumors often demonstrate estrogen receptor positivity. Thus, hormonal agents have been evaluated as potential treatments for advanced stage or recurrent adult granulosa cell tumors.

CASE

Two cases of patients with recurrent adult granulosa cell tumors are presented. Each patient received multiple treatment modalities including chemotherapy and had previously progressed on leuprolide. Both patients were started on anastrozole with subsequent normalization of inhibin B levels and clinical exams. They have been maintained on treatment for 14 and 18 months, respectively, and have tolerated the drug without difficulty.

CONCLUSION

Aromatase inhibitors may be a viable treatment option for women with advanced stage or recurrent ovarian adult granulosa cell tumors.

Economic evaluation of aromatase inhibitors for the treatment of breast cancer

Breast cancer affects 1 million women a year. Hormonal therapy has been a mainstay of treatment for women with hormone-sensitive breast cancer. The newer class of aromatase inhibitors has challenged the use of the previous standard agent, tamoxifen, in the treatment and prevention of breast cancer. This article will provide a thorough review of the literature on the newer generation aromatase inhibitors and examine their role in metastatic, adjuvant, neoadjuvant and prevention settings. An in-depth review of the cost-efficiency analyses is also performed. Recent studies on the newer, third-generation aromatase inhibitors have challenged the previous gold standard (tamoxifen) in the prevention and management of hormone-sensitive breast cancer in postmenopausal women. These studies have supported the use of aromatase inhibitors as first-line therapy in both early (adjuvant) and advanced breast cancer management. Whether aromatase inhibitors should replace tamoxifen in these settings is still a matter of debate. Augmenting these studies and providing additional information to the debate are pharmacoeconomic appraisals, which help to place a societal value on newer therapies as compared with the previously established therapy. This review discusses the pharmacology and efficacy of the newer aromatase inhibitors as it applies to their role in the metastatic, adjuvant, neoadjuvant and prevention settings. The pharmacoeconomic studies performed on these agents are also discussed.

Advances in breast cancer treatment and prevention: preclinical studies on aromatase inhibitors and new selective estrogen receptor modulators (SERMs)

Intensive basic and clinical research over the past 20 years has yielded crucial molecular understanding into how estrogen and the estrogen receptor act to regulate breast cancer and has led to the development of more effective, less toxic, and safer hormonal therapy agents for breast cancer management and prevention. Selective potent aromatase inhibitors are now challenging the hitherto gold standard of hormonal therapy, the selective estrogen-receptor modulator tamoxifen. Furthermore, new selective estrogen-receptor modulators such as arzoxifene, currently under clinical development, offer the possibility of selecting one with a more ideal pharmacological profile for treatment and prevention of breast cancer. Two recent studies in preclinical model systems that evaluate mechanisms of action of these new drugs and suggestions about their optimal clinical use are discussed.