- Question from Miki: Is the ATAC study still going on? Are the results pointing to a recommendation of taking Arimidex for five years for estrogen-receptor positive cancers? Any recommendations for after the five years of Arimidex? Are any serious side effects showing up in women who have taken Arimidex for several years?
- Answers —Jennifer Griggs, M.D., M.P.H.: Last year, Dr. Robert and I were at a Breastcancer.org conference together talking about the fact that there are just as many facts as there are questions, as with any good study. Decisions about hormonal treatment after breast cancer surgery offer many choices for women and their doctors. There are some tumors in which the aromatase inhibitors are clearly superior. For example, tumors that have the estrogen receptor but do not have the progesterone receptor appear to be better treated with the aromatase inhibitors than with tamoxifen. Medical experts are fairly passionate about this decision and several different treatment strategies have been proposed. For example, starting somebody on tamoxifen and then changing to an aromatase inhibitor is a strategy some doctors prefer. Other doctors choose the aromatase inhibitors in all postmenopausal women. Some people give five years of tamoxifen followed by five years of an aromatase inhibitor. The biggest problem I'm having is in my patients who've had five years of an aromatase inhibitor after surgery and then want to know what to do. Do they continue on the aromatase inhibitor for another five years? Would switching to tamoxifen in that case make sense? Or are they all done with hormonal treatments? Fortunately, we have studies of these questions going on right now. In the meantime, you and your doctor need to balance the benefits and risk of tamoxifen and the aromatase inhibitors and make a decision in your specific case.
- Nicholas Robert, M.D.: In terms of the question of the duration of Arimidex (chemical name: anastrozole) after five years, there will be a study soon available to try to address that question. It's a trial that already is opened in which patients after five years of tamoxifen took another aromatase inhibitor called letrozole, also known as Femara. After five years of letrozole, patients are being randomized to continue letrozole or stop. This clinical trial will also be open to patients who've been on an aromatase inhibitor for five years. These patients will be eligible for this trial as well. This will give us some information about the duration of aromatase inhibitors. In terms of side effects, it's become clear that women on aromatase inhibitors lose bone and they need to be monitored closely for bone loss. Also, there continues to be some controversy about increased lipids like cholesterol in patients who are on aromatase inhibitors, so this is another health factor that needs to be monitored.
On Wednesday, June 21, 2006, our Ask-the-Expert Online Conference was called Updates from the 2006 ASCO Annual Meeting. Nicholas Robert, M.D. and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about recent advances in breast cancer treatment, updates on breast cancer genetics, information on diet and risk of recurrence, and more.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Nicholas Robert, M.D. is a co-chair of the Breast Committee of the U.S. Oncology Research Network and also chairs the Cancer Committee and Research Committee of the Inova Fairfax Hospital's Cancer Center.
Jennifer Griggs, M.D., M.P.H. is a medical oncologist specializing in the treatment of breast cancer, with a a special interest in cancer survivorship, patient-physician communication, and quality of care for women with breast cancer.
