Biomedical Engineering Reference
In-Depth Information
42,43
analyses, prospective evidence has yet to be established.
The
clinical impact of co-administration of CYP2D6 inhibitors, e.g.
selective serotonin reuptake inhibitors (SSRIs), has not been fully
evaluated at this time. Nonetheless, drugs that inhibit CYP2D6
should be used with caution.
In addition to tamoxifen, ovarian suppression/ablation is also an
effective adjuvant endocrine therapy for premenopausal women with
hormone-receptor positive breast cancer.
Surgical oophorectomy
and pharmacologic ovarian suppression with luteinizing
hormone-releasing hormone (LHRH) agonists are commonly used
approaches.
2
44
While surgical oophorectomy permanently stops
ovarian steroid production, pharmacological ovarian function
suppression using agents such as the LHRH agents cause reversible
and non-permanent ovarian dysfunction. Therefore, suppression
of ovarian function may be incomplete or may require significant
amount of time in some women. If pharmacological agents are
used for this purpose, biochemical verification of ovarian function
suppression through laboratory evaluation should be performed.
Radiation can also be used to induce ovarian ablation; however, it is
less frequently used.
45
5.4.1.2 Postmenopausal patients
Tamoxifen is approved for adjuvant treatment of node-positive
or node-negative breast cancer following total mastectomy or
segmental mastectomy, axillary dissection, and/or breast irradiation
in postmenopausal women with breast cancer. Three aromatase
inhibitors,
®
®
letrozole
(Femara
),
anastrozole
(Arimidex
),
and
®
) are also approved by the FDA for the
adjuvant treatment of hormone receptor-positive breast cancer in
the postmenopausal patient population.
exemestane (Aromasin
5.4.1.2.1
Tamoxifen
Early randomized clinical trials clearly demonstrated that adjuvant
tamoxifen treatment for 5 years reduces the risk of disease
recurrence and prolongs survival.
46,47
As discussed in Section 5.3.2,
the Oxford overviews fully established the effectiveness of tamoxifen
as adjuvant therapy. For postmenopausal patients, the indication of
adjuvant tamoxifen is the same as that for premenopausal women
as mentioned earlier. Side effects of tamoxifen are similar to those of
