Factor V Leiden Mutation and Thromboembolism Risk in Women Receiving Adjuvant Tamoxifen for Breast Cancer
| Autor: | Judy E, Garber, Susan, Halabi, Sara M, Tolaney, Ellen, Kaplan, Laura, Archer, James N, Atkins, Stephen, Edge, Charles L, Shapiro, Lynn, Dressler, Electra D, Paskett, Electra M, Paskett, Gretchen, Kimmick, James, Orcutt, Anthony, Scalzo, Eric, Winer, Ellis, Levine, Nasir, Shahab, Nancy, Berliner |
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| Rok vydání: | 2010 |
| Předmět: |
Selective Estrogen Receptor Modulators
Oncology Cancer Research medicine.medical_specialty Antineoplastic Agents Hormonal Breast Neoplasms Breast cancer Estrogen Receptor Modulators Breast Cancer Prevention Trial Risk Factors Thromboembolism Internal medicine Odds Ratio Prevalence medicine Humans Risk factor skin and connective tissue diseases Aged Gynecology business.industry Smoking Factor V Cancer Articles Middle Aged medicine.disease Antiestrogen Tamoxifen Logistic Models Chemotherapy Adjuvant Selective estrogen receptor modulator Case-Control Studies Multivariate Analysis Mutation Female Breast disease business medicine.drug |
| Zdroj: | JNCI Journal of the National Cancer Institute. 102:942-949 |
| ISSN: | 1460-2105 0027-8874 |
| Popis: | More people receive tamoxifen for cancer than any other drug or therapy (1). Tamoxifen improves disease-free and overall survival as an adjuvant treatment for pre- and postmenopausal patients with hormone receptor–positive breast cancer (2), induces prolonged responses in patients with hormonally responsive metastatic disease, and substantially reduces the incidence of breast cancer in women at increased risk for the disease (3). However, thromboembolic events (TEs) are among the most serious complications associated with tamoxifen use. In a metaanalysis of four primary prevention trials that compared tamoxifen vs a placebo, tamoxifen use was estimated to increase overall TE risk in healthy women by about twofold (relative risk = 1.9, 95% confidence interval [CI] = 1.4 to 2.6) and to be associated with even higher risks in women aged 50 years or older (4). In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14 trial, in which 5 years of adjuvant tamoxifen use was compared with use of a placebo in women with estrogen receptor– positive lymph node–negative breast cancer, the incidence of TE was fourfold greater overall in the tamoxifen-treated group (1.7%) than in the group receiving placebo (0.4%), with the majority of events in women aged 50 years and older (5). The prothrombotic effect of 6 months of adjuvant chemotherapy plus tamoxifen was assessed in the NSABP B-20 trial, in which women who received adjuvant chemotherapy plus tamoxifen had approximately threefold more TE (6.5%–7.0%) than women who took tamoxifen alone (1.8%). The increased risk was limited to the treatment period (6,7). Although the thrombogenic effect of tamoxifen is well documented, the effect of underlying breast cancer is less well quantified. In the B-14 trial, women with breast cancer in the placebo group had a higher rate of breast cancer recurrence than did women in the tamoxifen-treated group. However, the cumulative TE rate in the placebo group was about 0.4% over 5 years, the same rate as among women who took a placebo in the NSABP P-1 Breast Cancer Prevention Trial, in which participants had elevated breast cancer risk but no breast cancer history. |
| Databáze: | OpenAIRE |
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