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Indications and limitations of third-generation aromatase inhibitors
Per Eystein Lønning1, Jürgen Geisler
1Haukeland University Hospital, Department of Oncology, N-5021, Bergen, Norway. per.lonning@helse-bergen.no
Background:
Use of aromatase inhibitors in postmenopausal breast cancer, initially in advanced disease but recently also for adjuvant therapy, represents a major advance.
Objective:
To summarize research leading to this success and to review clinical data from large Phase III trials revealing efficacy of novel third-generation aromatase inhibitors in metastatic and early breast cancer.
Methods:
Literature on PubMed and on ISI Web of Science for the last 10 years was searched using the word 'aromatase'. Recent key presentations and abstracts are also included.
Results/Conclusion:
Third-generation aromatase inhibitors improve relapse-free survival compared to tamoxifen, and some trials reveal a survival advantage in early breast cancer. Although substantial data now confirm the safety of these potent compounds with respect to bone metabolism and cardiovascular risk, there is a need for continuous long-term follow-up, in particular into potential vascular effects. The mechanisms and optimal treatment of musculoskeletal and joint pain remain to be addressed. Ongoing studies evaluate sequential treatment versus monotherapy, potential differences between individual compounds and optimal duration of treatment, as well as combining aromatase inhibitors with novel targeting agents.
Insights
Third-generation aromatase inhibitors significantly improve survival for postmenopausal women with early breast cancer compared to tamoxifen. Ongoing research focuses on long-term safety and optimizing treatment strategies.
Area of Science:
- Oncology
- Pharmacology
Background:
- Aromatase inhibitors are a significant advancement in treating postmenopausal breast cancer.
- Their use has expanded from advanced disease to adjuvant therapy.
Purpose of the Study:
- To review the research behind aromatase inhibitor success.
- To analyze clinical data on third-generation aromatase inhibitors for breast cancer.
Main Methods:
- Searched PubMed and ISI Web of Science for 'aromatase' literature from the last 10 years.
- Included recent key presentations and abstracts.
Main Results:
- Third-generation aromatase inhibitors enhance relapse-free survival versus tamoxifen.
- Some trials indicate a survival benefit in early breast cancer patients.
Conclusions:
- Long-term follow-up is needed for potential vascular effects.
- Further research is required for musculoskeletal pain management.
- Ongoing studies explore sequential treatments, individual compound differences, optimal duration, and combination therapies.
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