Exemestane: One part of the chemopreventive spectrum for ER-positive breast cancer

Barbara K. Dunn, Massimiliano Cazzaniga, Andrea DeCensi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Development of drugs to prevent breast cancer has focused largely on anti-estrogenic agents, leading to approval by the US FDA of two such agents for this purpose: tamoxifen and raloxifene. However, the uptake of these drugs by high-risk women and their primary care physicians has been limited, due in large part to a perceived unfavorable risk:benefit balance. The current focus is on aromatase inhibitors, which appear to have more acceptable side effects in addition to being more efficacious in reducing breast cancer risk in high-risk women. The placebo-controlled phase III MAP.3 trial tested the AI exemestane in high-risk women and documented a 65% relative reduction in total and a 73% reduction in ER-positive breast cancers in the intervention compared to the placebo group. Toxicities centered around musculoskeletal side effects, but in the relatively short 35-month median follow-up period, these did not impair quality-of-life. A bone study nested within MAP.3 demonstrated significant decreases in bone mineral density (BMD) and in structural parameters of bone quality. The strengths and weaknesses of preventive exemestane as evaluated in the MAP.3 trial are discussed as are relevant areas for future consideration: influence of obesity, alternative dosing, and biomarker use in phase III prevention trials of aromatase inhibitors.

Original languageEnglish
Pages (from-to)225-237
Number of pages13
JournalBreast
Volume22
Issue number3
DOIs
Publication statusPublished - Jun 2013

Fingerprint

exemestane
Breast Neoplasms
Aromatase Inhibitors
Placebos
Bone and Bones
Primary Care Physicians
Tamoxifen
Pharmaceutical Preparations
Bone Density
Estrogens
Obesity
Biomarkers
Quality of Life

Keywords

  • Aromatase inhibitors
  • Breast cancer prevention
  • Exemestane
  • MAP.3 trial
  • Selective estrogen receptor modulators

ASJC Scopus subject areas

  • Surgery

Cite this

Exemestane : One part of the chemopreventive spectrum for ER-positive breast cancer. / Dunn, Barbara K.; Cazzaniga, Massimiliano; DeCensi, Andrea.

In: Breast, Vol. 22, No. 3, 06.2013, p. 225-237.

Research output: Contribution to journalArticle

Dunn, Barbara K. ; Cazzaniga, Massimiliano ; DeCensi, Andrea. / Exemestane : One part of the chemopreventive spectrum for ER-positive breast cancer. In: Breast. 2013 ; Vol. 22, No. 3. pp. 225-237.
@article{8ea78bd1727746bf970cf49d58456e71,
title = "Exemestane: One part of the chemopreventive spectrum for ER-positive breast cancer",
abstract = "Development of drugs to prevent breast cancer has focused largely on anti-estrogenic agents, leading to approval by the US FDA of two such agents for this purpose: tamoxifen and raloxifene. However, the uptake of these drugs by high-risk women and their primary care physicians has been limited, due in large part to a perceived unfavorable risk:benefit balance. The current focus is on aromatase inhibitors, which appear to have more acceptable side effects in addition to being more efficacious in reducing breast cancer risk in high-risk women. The placebo-controlled phase III MAP.3 trial tested the AI exemestane in high-risk women and documented a 65{\%} relative reduction in total and a 73{\%} reduction in ER-positive breast cancers in the intervention compared to the placebo group. Toxicities centered around musculoskeletal side effects, but in the relatively short 35-month median follow-up period, these did not impair quality-of-life. A bone study nested within MAP.3 demonstrated significant decreases in bone mineral density (BMD) and in structural parameters of bone quality. The strengths and weaknesses of preventive exemestane as evaluated in the MAP.3 trial are discussed as are relevant areas for future consideration: influence of obesity, alternative dosing, and biomarker use in phase III prevention trials of aromatase inhibitors.",
keywords = "Aromatase inhibitors, Breast cancer prevention, Exemestane, MAP.3 trial, Selective estrogen receptor modulators",
author = "Dunn, {Barbara K.} and Massimiliano Cazzaniga and Andrea DeCensi",
year = "2013",
month = "6",
doi = "10.1016/j.breast.2013.02.015",
language = "English",
volume = "22",
pages = "225--237",
journal = "Breast",
issn = "0960-9776",
publisher = "Churchill Livingstone",
number = "3",

}

TY - JOUR

T1 - Exemestane

T2 - One part of the chemopreventive spectrum for ER-positive breast cancer

AU - Dunn, Barbara K.

AU - Cazzaniga, Massimiliano

AU - DeCensi, Andrea

PY - 2013/6

Y1 - 2013/6

N2 - Development of drugs to prevent breast cancer has focused largely on anti-estrogenic agents, leading to approval by the US FDA of two such agents for this purpose: tamoxifen and raloxifene. However, the uptake of these drugs by high-risk women and their primary care physicians has been limited, due in large part to a perceived unfavorable risk:benefit balance. The current focus is on aromatase inhibitors, which appear to have more acceptable side effects in addition to being more efficacious in reducing breast cancer risk in high-risk women. The placebo-controlled phase III MAP.3 trial tested the AI exemestane in high-risk women and documented a 65% relative reduction in total and a 73% reduction in ER-positive breast cancers in the intervention compared to the placebo group. Toxicities centered around musculoskeletal side effects, but in the relatively short 35-month median follow-up period, these did not impair quality-of-life. A bone study nested within MAP.3 demonstrated significant decreases in bone mineral density (BMD) and in structural parameters of bone quality. The strengths and weaknesses of preventive exemestane as evaluated in the MAP.3 trial are discussed as are relevant areas for future consideration: influence of obesity, alternative dosing, and biomarker use in phase III prevention trials of aromatase inhibitors.

AB - Development of drugs to prevent breast cancer has focused largely on anti-estrogenic agents, leading to approval by the US FDA of two such agents for this purpose: tamoxifen and raloxifene. However, the uptake of these drugs by high-risk women and their primary care physicians has been limited, due in large part to a perceived unfavorable risk:benefit balance. The current focus is on aromatase inhibitors, which appear to have more acceptable side effects in addition to being more efficacious in reducing breast cancer risk in high-risk women. The placebo-controlled phase III MAP.3 trial tested the AI exemestane in high-risk women and documented a 65% relative reduction in total and a 73% reduction in ER-positive breast cancers in the intervention compared to the placebo group. Toxicities centered around musculoskeletal side effects, but in the relatively short 35-month median follow-up period, these did not impair quality-of-life. A bone study nested within MAP.3 demonstrated significant decreases in bone mineral density (BMD) and in structural parameters of bone quality. The strengths and weaknesses of preventive exemestane as evaluated in the MAP.3 trial are discussed as are relevant areas for future consideration: influence of obesity, alternative dosing, and biomarker use in phase III prevention trials of aromatase inhibitors.

KW - Aromatase inhibitors

KW - Breast cancer prevention

KW - Exemestane

KW - MAP.3 trial

KW - Selective estrogen receptor modulators

UR - http://www.scopus.com/inward/record.url?scp=84877113203&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84877113203&partnerID=8YFLogxK

U2 - 10.1016/j.breast.2013.02.015

DO - 10.1016/j.breast.2013.02.015

M3 - Article

C2 - 23535509

AN - SCOPUS:84877113203

VL - 22

SP - 225

EP - 237

JO - Breast

JF - Breast

SN - 0960-9776

IS - 3

ER -