Medications May Boost Breast Cancer Prevention Therapies
Women fear breast cancer more than almost any other illness.
Wouldn't it be wonderful, many have wondered, if there were a drug that could prevent the disease?
As it happens, there is. In fact, there are several.
But few women take them, says Rowan Chlebowski of the Los Angeles Biomedical Research Institute. The Food and Drug Administration has approved two pills to prevent breast cancer in older women or those at high risk: tamoxifen, a standard of breast cancer therapy, and raloxifene, also known as Evista, which is commonly used to treat osteoporosis. Both cut the risk of breast tumors by about half.
But both can cause significant side effects.
Both increase the risk of life-threatening complications such as blood clots, strokes and uterine cancer, as well as problems such as hot flashes and vaginal dryness, according to the National Cancer Institute.
The drugs are used by only 1% to 4% of eligible women those who are at least age 60 or younger women with other risk factors, such as a close relative with breast cancer, Chlebowski says.
Promising new developments
But Chlebowski says new research may persuade more women to try a cancer prevention drug.
In a study of 4,520 postmenopausal women at high risk for breast cancers, Chlebowski and colleagues found that a drug called exemestane reduced the risk of breast cancer by 65% without causing as many serious side effects as other pills. Doctors have not studied the drug in younger women without additional risk factors.
Exemestane is already on the market and commonly prescribed to breast cancer patients to keep their tumors from coming back. The drug, sold under the brand name Aromasin, belongs to a class of medications called aromatase inhibitors, which deprive breast cancers of estrogen, a hormone that fuels the majority of breast tumors.
Researchers followed women in the study closely because aromatase inhibitors can cause side effects such as bone loss. Yet doctors found no increase in osteoporosis, bone fractures, high cholesterol or heart attacks, says the study, presented Saturday at the American Society of Clinical Oncology's annual meeting in Chicago. Pfizer, which makes exemestane, helped pay for the study.
The biggest problem for women taking it was joint pain; 3.5% reported severe joint pain, compared with 1.5% of women taking a placebo, Chlebowski says.
"This is very exciting news," says Terese Bevers, a breast cancer specialist at Houston's M.D. Anderson Cancer Center, who wasn't involved in the new research. "It's the opportunity to never have to tell a woman, 'You have breast cancer.'"
More options than ever
She says high-risk women now have options to prevent breast cancers. If they develop side effects on one of the three drugs, they can try another, she says.
Chlebowski notes that cost could keep women from trying exemestane. The brand-name drug costs $300 to $400 a month, he says. That could drop in coming months, however, when exemestane's patent expires.
Yet some experts still urge caution.
There's no evidence that any of these drugs actually save lives, says Vered Stearns of the Johns Hopkins University School of Medicine.
That may be because the drugs prevent only slow-growing or less aggressive tumors, which can be cured through standard treatment, Stearns says.
Patricia Ganz, who treats high-risk women at the UCLA School of Medicine, notes that the study tracked women for only three years. So it's possible that more will develop side effects over time.
"One study does not change therapy," says Ganz, who wasn't involved in the new research.
Researchers could resolve many questions about exemestane through a study that directly compares it with tamoxifen or raloxifene, Ganz says.
And in spite of exemestane's success, many doctors may not be comfortable prescribing it, says Claudine Isaacs of Georgetown's Lombardi Comprehensive Cancer Center. Gynecologists and other doctors women consult about breast cancer prevention may remain reluctant to suggest it, Isaacs says.
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