Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer
| Autor: | Daniel F. Hayes, Vered Stearns, Elizabeth Yakim, Faouzi Azzouz, Suzanne Lemler, N. Lynn Henry, Karineh Tarpinian, David A. Flockhart, Jill Hayden, Z. Desta, Anne T. Nguyen, Lang Li, Anna Maria Storniolo |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Oncology
Adult Cancer Research medicine.medical_specialty Neoplasms Hormone-Dependent medicine.drug_class Breast Neoplasms Comorbidity Medication Adherence Breast cancer Internal medicine Nitriles Original Reports medicine Humans Prospective Studies Aromatase Stage (cooking) Aged Gynecology Aged 80 and over Aromatase inhibitor biology business.industry Aromatase Inhibitors Middle Aged Triazoles medicine.disease Prognosis Discontinuation Androstadienes Withholding Treatment Toxicity Letrozole biology.protein Female business Hormone Follow-Up Studies |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 30(9) |
| ISSN: | 1527-7755 |
| Popis: | Purpose Aromatase inhibitors (AIs) are effective for treatment of hormone receptor–positive breast cancer, but adherence and persistence with therapy are poor. Predictors of treatment discontinuation are not clearly defined. It is unknown whether patients with intolerable toxicity from one AI are able to tolerate another. Patients and Methods Women with early-stage breast cancer initiating AI therapy were enrolled onto a multicenter, prospective, open-label randomized trial of exemestane versus letrozole. Patients completed symptom questionnaires at baseline and serially during therapy. Patients who developed AI-associated intolerable symptoms and discontinued treatment were given the option to switch to the other study AI after a 2- to 8-week washout period. Results Of the 503 enrolled women, 32.4% discontinued initial AI therapy within 2 years because of adverse effects; 24.3% discontinued specifically because of musculoskeletal symptoms. Median time to treatment discontinuation as a result of any symptom was 6.1 months (range, 0.1 to 21.2 months) and was significantly shorter in patients randomly assigned to exemestane (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = .02). Younger age and taxane-based chemotherapy were associated with higher likelihood of treatment discontinuation (HR, 1.4; 95% CI, 1.02 to 1.9; P = .04; and HR, 1.9; 95% CI, 1.00 to 3.6; P = .048, respectively). Of the 83 patients who chose to switch to the second AI, 38.6% continued the alternate AI for a median of 13.7 months. Conclusion Premature discontinuation of initial AI therapy as a result of symptoms is common, although more than one third of patients may be able to tolerate a different AI medication. Additional research is needed to identify predictive tools and interventions for AI-associated treatment-emergent symptoms. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|