Aromatase inhibitors for breast cancer

Examples

Generic Name	Brand Name
anastrozole	Arimidex
exemestane	Aromasin
letrozole	Femara

Aromatase inhibitors are available as tablets. Follow your doctor's orders or the directions on the label.

How It Works

Aromatase inhibitors interfere with how much estrogen the body's tissues can make. This limits the amount of estrogen available in the body.

An aromatase inhibitor cannot lower estrogen levels made by the ovaries. That is why an aromatase inhibitor only works after menopause, when a woman's ovaries have stopped making estrogen and other hormones.¹

Why It Is Used

Aromatase inhibitors are used to treat early estrogen receptor-positive (ER+)breast cancer. They are also used to treat metastatic or recurrent ER+ breast cancer. An aromatase inhibitor can be used alone or after tamoxifen treatment.

Some doctors may use aromatase inhibitor "off-label" to treat infertility and endometriosis. This means that the U.S. Food and Drug Administration (FDA) has not approved this use.

How Well It Works

Several studies have shown that the use of aromatase inhibitors after menopause make ER+ breast cancer less likely to come back. Studies suggest that this is true for:

• First-time localized breast cancer.²
• New breast cancer that develops while tamoxifen is being taken.³
• Metastatic breast cancer.

Recent studies have shown that aromatase inhibitors work better than tamoxifen, a standard treatment for ER+ breast cancer.^{2, 4} Aromatase inhibitors also work better than tamoxifen when used to treat recurrent or advanced breast cancer.³

Endometriosis. In small studies, aromatase inhibitors have been shown to reduce both pain and the chance of endometriosis growths coming back. Aromatase inhibitors may help women who have endometriosis but who have not had relief with hormonal treatments. Aromatase inhibitors are used with a hormonal treatment (such as birth control hormones or progestin). Long-term use of aromatase inhibitors may cause bone loss. More research needs to be done before it is known how well this treatment works and what the side effects are.⁵

Side Effects

Possible side effects of an aromatase inhibitor include:

• Hot flashes.
• Muscle or body aches.
• Mild nausea.
• Diarrhea or constipation.
• A general feeling of illness.
• Weakness and fatigue.
• Bone thinning. Aromatase inhibitors increase the rate of bone thinning that occurs normally in postmenopausal women.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

For breast cancer treatment, aromatase inhibitors should be given only under the supervision of a medical oncologist.

Further study is needed to determine how long to continue treatment with aromatase inhibitors. The follow-up time of recent studies is limited, and the benefits of aromatase inhibitors must be weighed against the potential for side effects.⁴

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Author:	Kathe Gallagher, MSW	Last Updated: August 31, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Douglas A. Stewart, MD - Medical Oncology
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