Women's Health: A Better Breast-Cancer Treatment?
Taking tamoxifen for five years after breast-cancer surgery nearly halves the risk of a recurrence in women whose cancer's growth is fueled by estrogen. But a newer class of drugs called aromatase inhibitors has been gaining favor, with many studies suggesting that these medications can boost survival even more when used after tamoxifen therapy or even in place of the older drug.
Two new studies have added to the evidence this week. Both reported that switching to an aromatase inhibitor after two or three years on tamoxifen improves the odds of survival compared with finishing out the five years on tamoxifen. One study, appearing in the journal Cancer, looked over 800 women over an average of more than six years. Four hundred kept taking tamoxifen, while the other half switched to one of two aromatase inhibitors. Of those on tamoxifen, 51 women died of breast-cancer related causes. In the group that switched drugs, 33 women did. The Lancet study, which followed nearly 5,000 women, also found fewer recurrences and better survival rates among women who switched drugs, and the benefit persisted after the five years of therapy ended.
The precise formula for combining the drugs to best effect–which one first and for how long?–isn't known, says Cheryl Perkins, senior clinical adviser for Susan G. Komen for the Cure, a breast cancer advocacy organization. It's also not yet clear which aromatase inhibitor might do the best job. Right now, women eligible for aromatase inhibitors–that is, women who are postmenopausal and have had cancer–should talk to their doctors about the best course of action. Decisions will vary depending on a woman's medical history, since tamoxifen can cause clots and endometrial cancer, while the newer drugs can weaken bones and cause heart problems in some women. Meantime, studies continue on how best to use the drugs.
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