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Questions about Hormone Blockers: Side Effects?

Breast Cancer | Last Active: Aug 6, 2020 | Replies (27)
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@lindalm

Hi Colleen,
Thank-you so much for the links, especially for the Hormonal Therapy Side Effects Comparison Chart. I’m about to start taking an Aromatase Inhibitor. My oncologist said I could choose any of the three. But with all the serious side effects, and to make that decision, I’m looking for randomized controlled trials (RCT) that answer these questions:
1. Are there links to RCT trials that demonstrate the efficacy of these drugs > Arimidex (anastrozole) vs. Aromasin (exemestane) vs. Femara (letrozole) vs. a control group of women who do not take an AI? It would be ideal to see any more recent reports that reevaluated the efficacy and where more years of data were included.
2. My oncologist indicated the standard AI dosage is exactly the same for every woman regardless of stage/grade/type of estrogen positive breast cancer. Are there any RCT studies available where the dosage was evaluated based on the severity of the cancer? Did the trials dosage determination include that criteria too?
3. The oncologist also noted the standard dosage is the same if the woman weighs 90 or 395+ pounds. Are there any RCT studies available where the dosage was evaluated based on the patients weight or BMI?

I’ve looked for this info on many websites including the FDA, NIH, Mayo clinic and more without luck and truly appreciate any info you may provide.

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Replies to "Hi Colleen, Thank-you so much for the links, especially for the Hormonal Therapy Side Effects Comparison..."
Kanaaz Pereira, Connect Moderator | @kanaazpereira | Aug 14, 2019

Welcome to Connect, @lindalm. I can only imagine the many questions you must have before making a decision! Here’s some information I found – although this may not pertain specifically to RCTs, they are all recently published studies based on clinical trials – are you ready for a lot of reading? 🙂

Q1.
– First Trial of Three Aromatase Inhibitors: Similar Efficacy, Safety https://www.medscape.com/viewarticle/894890
"This is also the first trial to compare an up-front treatment schedule with a switch schedule using anastrozole, the study authors note. The up-front schedule consisted of 5 years of treatment with aromatase inhibitors; the switch schedule consisted of 2 years of treatment with tamoxifen followed by 3 years of treatment with aromatase inhibitors.”
– Risk–benefit ratio requires ‘highly individualized’ plan for extended aromatase inhibitor therapy http://bit.ly/303EY7x

Q2.
– Optimizing the Use of Aromatase Inhibitors https://www.cancernetwork.com/supplements-2009-breast-cancer/optimizing-use-aromatase-inhibitors
– Aromatase Inhibitors in Gynecologic Practice http://bit.ly/2N5DSEC
"What is the best sequence, timing, and duration of AI use? Conclusions and recommendations of The American College of Obstetricians and Gynecologists”

Q3.
– Efficacy of letrozole, anastrozole linked to BMI http://bit.ly/33BdmsE
– The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial https://www.nature.com/articles/bjc2013367

I hope this helps, @lindalm. We look forward to getting to know you – could you share a few more details about your health?

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