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Sequencing of aromatase inhibitors

G Bertelli1

  • 1South West Wales Cancer Institute, Sketty, Swansea SA2 8QA, UK. gianfilippo.bertelli@swansea-tr.wales.nhs.uk

British Journal of Cancer
|August 16, 2005
PubMed

Insights

Third-generation aromatase inhibitors (AIs) like anastrozole are key in advanced breast cancer treatment. Research explores optimal sequencing of AIs and other therapies for prolonged patient benefit.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Third-generation aromatase inhibitors (AIs) – anastrozole, letrozole, and exemestane – have significantly impacted advanced breast cancer treatment.
  • These agents have become standard in second-line therapy and are challenging tamoxifen in first-line settings.

Purpose of the Study:

  • To review the optimal use of third-generation aromatase inhibitors in advanced breast cancer.
  • To explore the potential for sequential use of steroidal and nonsteroidal AIs due to a lack of cross-resistance.
  • To address remaining questions regarding the best sequencing of AIs, tamoxifen, and fulvestrant.

Main Methods:

  • Literature review and analysis of clinical research on aromatase inhibitors in advanced breast cancer.
  • Examination of treatment guidelines and clinical trial data regarding AI sequencing.
  • Synthesis of evidence on cross-resistance patterns between steroidal and nonsteroidal AIs.

Main Results:

  • Third-generation AIs have replaced progestins in second-line therapy and are increasingly used in the first-line setting.
  • Evidence suggests a lack of cross-resistance between steroidal and nonsteroidal AIs, supporting sequential therapy.
  • Optimal sequencing strategies for AIs, tamoxifen, and fulvestrant remain under investigation for different patient populations.

Conclusions:

  • Anastrozole, letrozole, and exemestane are crucial in managing advanced breast cancer.
  • Sequential use of different AI classes may offer prolonged clinical benefit.
  • Further research is needed to define optimal treatment sequences involving AIs and other endocrine agents.

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