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You are here: Home: BCU 4|2002: Program Supplement: Case 3
Miami Breast Cancer
Conference
Tumor Board Case 3: Patrick Borgen, MD
A patient with invasive
disease at low risk for recurrence |
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| The patient is a 59-year-old postmenopausal
woman with an 0.8 cm invasive breast cancer. The pathology
is poorly differentiated, ER-positive, HER2-negative.
After 4 months of adjuvant tamoxifen, she developed
a 12-pound weight gain and severe hot flashes. How would
you treat her?
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Even before the preliminary results from the ATAC trial were presented,
many oncologists were substituting aromatase inhibitors for tamoxifen
in women with increased risk for thromboembolism or difficulty tolerating
tamoxifen. Most attendees recommended substituting anastrozole in
this patient. In fact, Dr Borgen made this change and the patient,
who was being treated with antidepressants, was able to lose the
gained weight and go off antidepressant medication. She has essentially
no symptoms at this time on anastrozole.
While hot flashes have clearly been associated with tamoxifen,
the NSABP P - 1 quality of life study did not find any significant
association between tamoxifen and weight gain, depression or sexual
function (side effects sometimes attributed to tamoxifen). Early
results from the ATAC trial indicate that anastrozole is associated
with both less episodes of hot flashes and weight gain than tamoxifen.
Baum M. The ATAC (Arimidex, Tamoxifen, Alone or in Combination)
adjuvant breast cancer trial in post-menopausal women. Breast
Cancer Res Treat 2001;69(3): Abstract
8.
Buzdar AU. Anastrozole (Arimidex) — an aromatase inhibitor
for the adjuvant setting? Br J Cancer 2001;85(2 suppl):6-10.
Abstract
Demissie S et al. Adjuvant tamoxifen: Predictors of use, side
effects, and discontinuation in older women. J Clin Oncol
2001;19(2):322-8. Abstract
Ganz P. Impact of tamoxifen adjuvant therapy on symptoms, functioning,
and quality of life. J Natl Cancer Inst Monogr 2001;30:130-134.
Abstract
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