The effect of anastrozole therapy on final height and sex hormone levels in pubertal boys receiving growth hormone therapy

ABSTRACT Objective: This research aimed to evaluate retrospectively the effect of anastrozole on height gain and sex hormone levels in pubertal boys receiving growth hormone (GH). Materials and methods: Pubertal boys who received both GH and anastrozole (GH+A) were one-to-one matched with boys who received only GH (GH-Only) for chronological and bone age, pubertal stage and height before the GH initiation, treatment duration and midparental height. Anthropometric measurements throughout treatment and adult heights were compared between the groups. Sex hormone levels were evaluated longitudinally in the GH+A group. Results: Forty-eight cases (24 in each group) were included. There was no statistical difference in adult height between the GH+A and GH-Only (p = 0.071). However, when the analysis was limited to those receiving anastrozole for at least 2 years, mean adult height was higher in the GH+A than in the GH-Only group (173.1 ± 6.2/169.8 ± 5.6 cm, p = 0.044). Despite similar growth rates between the two groups, bone age advancement was slower in the GH+A than in the GH-Only in a mean anastrozole treatment period of 1.59 years (1.37 ± 0.80/1.81 ± 0.98 years, p = 0.001). The greatest increase for FSH, LH, total and free testosterone and decrease for estradiol levels were observed in the third month after anastrozole was started, albeit remaining within the normal ranges according to the actual pubertal stages. Conclusions: Using anastrozole with GH for at least 2 years decelerates the bone age advancement resulting in adult height gain with no abnormality in sex hormone levels. These results suggest anastrozole can be used as an additional treatment to GH for further height gain in pubertal boys.

Switching of hormone therapies in breast cancer women / Avaliação da mudança do esquema hormonioterápico em mulheres com câncer de mama

Abstract Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer. Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017. Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, 'disease progression' was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, 'presence of side effects' was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities. Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.

Resumo Objetivo O objetivo do presente estudo foi analisar os motivos que levaram às mudanças no esquema hormonioterápico (HT) em mulheres com câncer de mama. Métodos Estudo transversal retrospectivo realizado no Hospital da Mulher de Campinas e consequente pesquisa de prontuários de mulheres diagnosticados com câncer de mama entre janeiro de 2012 e janeiro de 2017. Resultados De 1.555 mulheres em tratamento com HT, 213 (13,7%) mulheres tiveram HT alterado, tamoxifeno para anastrozol ou vice-versa. A maioria das mulheres incluídas no presente estudo que tiveram mudança de HT tinha > 50 anos, estava na pós-menopausa, era caucasiana e tinha pelo menos uma comorbidade. Os principais motivos de troca de HT foram devido a 'progressão da doença', ocorrendo em 124 (58,2%) casos e a 'presença de efeitos colaterais' (n = 65; 30,5%). Das mulheres que sofreram efeitos colaterais, 24 (36,9%) apresentaram comorbidades. Conclusão O presente estudo demonstrou uma baixa taxa na alteração de tamoxifeno para anastrozol. Entre as razõesmais comuns para alterar a HT estava a progressão da doença, que inclui recorrência do câncer, metástase ou aumento do tumor. Os efeitos colaterais foram a segunda causa e, além disso, a idade e as comorbidades foram fatores de risco para efeitos colaterais.

Breast cancer neoadjuvant endocrine therapy and COVID-19: a renewed breath with future perspectives

In 2020, the COVID-19 pandemic is the major healthcare concern around the world. The infection is especially severe to those with immune system suppression, including patients with cancer. In order to mitigate the negative effects of COVID-19, guidelines have been developed by societies worldwide to review oncology care during this pandemic time. Neoadjuvant endocrine therapy (NET) is a well-stablished option for hormone positive (HR) HER2 negative breast cancer and showed a positive response in breast conservative surgery with substantially less toxicity. Compared to chemotherapy, the NET cost is lower, and its administration is easier, due to less medical visits. Even with remarkable advantages, NET remains taking less place in treatments than it might have. Periods of humanity crisis, such as World Wars and other pandemics, boosted the development of science and established many treatments, which are currently practiced. New data generated during the COVID-19 outbreak can inspire more trials comparing chemotherapy to endocrine therapy within the neoadjuvant setting. The purpose of this letter is to suggest NET as a safe low toxicity treatment strategy for breast cancer, not only to postpone breast cancer surgery during the pandemic, but also to become a standard therapy, a flame kept burning crossing the COVID-19 border.

Effects of anastrozole on Ki-67 antigen expression in the vaginal epithelium of female rats in persistent estrus

OBJECTIVES: Aromatase inhibitors are the first-choice drugs for the treatment of hormone sensitive breast cancer. However, in addition to the scarcity of studies, there are controversies about their effects on vaginal epithelial cell proliferation in rats, especially those in persistent estrus. METHODS: To investigate vaginal epithelial cell proliferation by Ki-67 antigen expression, persistent estrus was induced in 42 randomly selected rats. These rats were randomly divided into 2 groups: group I (control, n=21), which received 0.1 mL of propylene glycol (vehicle) daily, and group II (experimental, n=21), which received 0.5 mg/kg or 0.125 mg/day of anastrozole diluted with 0.1 mL of propylene glycol. RESULTS: Light microscopy showed a higher concentration of cells with brown Ki-67 stained nuclei in the control compared to the experimental group. The mean percentage of Ki-67 stained nuclei per 500 cells in the vaginal epithelium was 68.64±2.64 and 30.46±2.00 [mean±standard error of the mean (SEM)] in the control and experimental groups, respectively (p<0.003). CONCLUSION: This study showed that anastrozole, at the dose and treatment duration selected, significantly decreased cell proliferation in the vaginal mucosa of the rats in persistent estrus.

Cytotoxic effect of transdermal invasomal anastrozole gel on MCF-7 breast cancer cell line

Introduction: Anastrozole is an anti-cancer drug, an effective aromatase inhibitor for the treatment of breast cancerin post-menopausal women. As it undergoes extensive first-pass metabolism and has many side effects related to oraluse, it has been envisaged to develop anastrozole invasomes in the form of transdermal gel.Objective: The objective of this work was to prepare, characterize, and evaluate invasomal gel of anastrozole.Materials and Methods: Invasomes were prepared by thin layer film hydration method using Phospholipon 80H,fenchone (terpene), and ethanol. The optimized invasomes were incorporated into sodium carboxy methyl cellulosegel. Prepared formulations were evaluated and cytotoxic study on Michigan cancer foundation (MCF)-7 cancer cellline was studied.Results and Discussion: The scanning electron microscope results of the optimized formulation showed sphericalshaped vesicles.The ex vivo permeation of invasomes and the skin deposition (73%) were studied on male Wistar ratskin. Cell line studies on MCF-7 cells showed cytotoxic effect of optimized formulation at 5 µl/ml.Conclusion: It was concluded that the developed anastrozole invasomes enhanced the transdermal flux and theresults obtained encouraged the use of the anastrozole invasomal gel for the potential treatment of breast cancer inpost-menopausal women.

Cytotoxic effect of transdermal invasomal anastrozole gel on MCF-7 breast cancer cell line

Introduction: Anastrozole is an anti-cancer drug, an effective aromatase inhibitor for the treatment of breast cancerin post-menopausal women. As it undergoes extensive first-pass metabolism and has many side effects related to oraluse, it has been envisaged to develop anastrozole invasomes in the form of transdermal gel.Objective: The objective of this work was to prepare, characterize, and evaluate invasomal gel of anastrozole.Materials and Methods: Invasomes were prepared by thin layer film hydration method using Phospholipon 80H,fenchone (terpene), and ethanol. The optimized invasomes were incorporated into sodium carboxy methyl cellulosegel. Prepared formulations were evaluated and cytotoxic study on Michigan cancer foundation (MCF)-7 cancer cellline was studied.Results and Discussion: The scanning electron microscope results of the optimized formulation showed sphericalshaped vesicles.The ex vivo permeation of invasomes and the skin deposition (73%) were studied on male Wistar ratskin. Cell line studies on MCF-7 cells showed cytotoxic effect of optimized formulation at 5 µl/ml.Conclusion: It was concluded that the developed anastrozole invasomes enhanced the transdermal flux and theresults obtained encouraged the use of the anastrozole invasomal gel for the potential treatment of breast cancer inpost-menopausal women

Association of CYP2C19 gene polymorphism with anastrozole in treatment of postmenopausal breast can-cer patients / 实用医学杂志

Objective To investigate the correlation between CYP2C19*2 gene polymorphism and efficacy of anastrozole in postmenopausal women with breast cancer. Methods The polymorphisms of CYP2C19*2 gene in postmenopausal women with postmenopausal breast cancer were detected by PCR. Results The A allele frequency of the CYP2C19*2 gene(OR=3.146,95% CI:1.244~7.275,P<0.05)was a risk factor for the efficacy of post-menopausal breast cancer patients.The survival rate was lower than that of GG(χ2=6.26,P<0.05).After treat-ment,the FSH and LH of GG patients were significantly lower than those of AA and GA(t=5.29,6.47,P<0.05). Multivariate logistic regression analysis showed that anastrozoleand CYP2C19*2 gene polymorphism were indepen-dently associated with serum FSH and LH levels in postmenopausal women with breast. Conclusion CYP2C19*2 gene polymorphism is associated with anastrozole in the treatment of postmenopausal breast cancer.

The use of aromatase inhibitors in boys with short stature: what to know before prescribing?

ABSTRACT Aromatase is a cytochrome P450 enzyme (CYP19A1 isoform) able to catalyze the conversion of androgens to estrogens. The aromatase gene mutations highlighted the action of estrogen as one of the main regulators of bone maturation and closure of bone plate. The use of aromatase inhibitors (AI) in boys with short stature has showed its capability to improve the predicted final height. Anastrozole (ANZ) and letrozole (LTZ) are nonsteroidal inhibitors able to bind reversibly to the heme group of cytochrome P450. In this review, we describe the pharmacokinetic profile of both drugs, discussing possible drug interactions between ANZ and LTZ with other drugs. AIs are triazolic compounds that can induce or suppress cytochrome P450 enzymes, interfering with metabolism of other compounds. Hydroxilation, N-dealkylation and glucoronidation are involved in the metabolism of AIs. Drug interactions can occur with azole antifungals, such as ketoconazole, by inhibiting CYP3A4 and by reducing the clearance of AIs. Antiepileptic drugs (lamotrigine, phenobarbital, and phenytoin) also inhibit aromatase. Concomitant use of phenobarbital or valproate has a synergistic effect on aromatase inhibition. Therefore, it is important to understand the pharmacokinetics of AIs, recognizing and avoiding possible drug interactions and offering a safer prescription profile of this class of aromatase inhibitors. Arch Endocrinol Metab. 2017;61(3):391-7.

Estrone and Estradiol Levels in Breast Cancer Patients Using Anastrozole Are Not Related to Body Mass Index / Níveis de estrona e estradiol em pacientes com câncer de mama usando anastrozol não estão relacionados ao índice de massa corpórea

ABSTRACT Objective: Obesity is associated with an increased risk for breast cancer. Recent studies have shown that aromatase inhibitors may be less effective in women with a high body mass index (BMI). The aim of this study was to establish the relationship between the BMI and plasma estrone and estradiol levels in postmenopausal women with hormone receptor-positive breast cancer using anastrozole. Methods: In this cohort study, the patients were divided into three groups according to BMI (normal weight, overweight and obese) to compare and correlate plasma hormone levels before starting anastrozole hormone therapy and three months after treatment. Plasma hormone levels were compared for age and use of chemotherapy. Results: A statistically significant reduction in estrone and estradiol levels was observed between baseline and three months after starting the anastrozole treatment (p < 0.05). There was no statistically significant difference in plasma estrone and estradiol levels among the BMI groups (p > 0.05), but a significant reduction in plasma estrone levels was observed after three-months' treatment relative to baseline in all groups, as well as a reduction in estradiol in the obese group (p < 0.05). The use of chemotherapy and age > 65 years had no influence on plasma steroid levels. Conclusion: Changes in estrone and estradiol levels in the studied groups were not associated with BMI, chemotherapy or age.

RESUMO Objetivo: A obesidade está associada com risco aumentado de câncer de mama. Estudos recentes têm mostrado que os inibidores de aromatase podem ser menos eficazes em mulheres com alto índice de massa corporal (IMC). O objetivo deste estudo foi estabelecer a relação entre o IMC e os níveis plasmáticos de estrona e estradiol em mulheres no período pós-menopausa com câncer de mama receptor hormonal positivo, em tratamento com anastrozol. Métodos: Este estudo de coorte acompanhou três grupos de pacientes de acordo com o seu IMC (peso normal, sobrepeso e obesidade), a fim de comparar e correlacionar as dosagens dos hormônios estrona e estradiol antes e após três meses do uso do anastrozol. Os níveis plasmáticos dos hormônios foram também relacionados à idade do paciente e ao uso da quimioterapia. Resultados: Redução estatisticamente significativa de estrona e estradiol foi observada entre os níveis basais e três meses após o início do tratamento com anastrozol (p < 0,05). Não houve diferença estatisticamente significativa entre os níveis plasmáticos de estrona e estradiol em relação ao IMC (p > 0,05), mas houve redução significativa entre os níveis plasmáticos basais de estrona após o tratamento em todos os grupos, e redução de estradiol no grupo de pacientes obesas (p < 0,05). A condução da quimioterapia e da idade acima de 65 anos não interfere com os níveis plasmáticos de esteroides. Conclusão: Os níveis plasmáticos de estrona e estradiol nos grupos estudados não foram alterados em termos de IMC, quimioterapia e idade.

Determination of the Related Substances in Anastrozole by Improving HPLC / 中国药房

OBJECTIVE:To establish a method for the determination of related substances in anastrozole. METHODS:HPLC was performed on the column of Welch Materials XB C18 with mobile phase of acetonitrile-water(35:65,V/V)at a flow rate of 1.0 mL/min,detection wavelength was 210 nm,column temperature of 25 ℃,and the injection volume was 20 μL. RESULTS:Only one impurity(impurity A)was detected in anastrozole,the linear range was 0.1-1.6 μg/mL(r=0.9996);limit of quantitation was 0.1 μg/mL,limit of detection was 0.02 μg/mL;RSDs of precision,stability and reproducibility tests were lower than 2%;recovery was 98.95%-105.29%(RSD%=1.78%,n=9). CONCLUSIONS:The method is simple,accurate,and can be used for the determination of related substances in anastrozole.

Effect of Anastrozole on Sex Hormone Levels and MCF-7 Cell Inhibition in Postmenopausal Women with Breast Cancer / 中国药师

Objective:To investigate the effect of anastrozole on sex hormone levels and michigan cancer foundation-7 ( MCF-7 ) cell inhibition in postmenopausal women with breast cancer. Methods: Totally 80 women with breast cancer were selected. Among them, 40 cases of patients received the routine management and tamoxifen treatment were included into the control group, and another 40 cases of patients received the routine management and anastrozole treatment were included into the observation group. The changes of sex hormone levels, effects and adverse drug reactions of two groups were compared between basetine and three months after treat-ment, meanwhile, the incidence of MCF-7 cell inhibition between two groups. Results:After treatment, the levels of estradiol( ER) , progesterone(PR) and luteotropic hormone(LH) were lower than baselime, however, the level of testosterone was contrary(P <0. 05). Meanwhile, the level of ER, PR and LH in control group were lower than baselime however, the level of testosterone was cont-ray (P<0. 05). The incidence of MCF-7 cell inhibillion between two grugs at time 72 h were higher than the 48 h, the incedence of MCF-7 cell inhibition in observation group were significantly higher than control groups at time 48 h and 72 h (P<0. 05). The rate of total effective in control group(45. 0%) was lower than the observation group(70. 0%)(P>0. 05). There was no significant differente in the micidence of adverse reactions. Conclusion:Anastrozole used for postmenopausal women with breast cancer has significant effi-cacy, high safety and promising inhibitory effect on MCF-7 cell. It can effectively adjust sex hormone level, reduce occurrence and transfer risks of breast cancer.

Effect of Anastrozole on Sex Hormone Levels and MCF-7 Cell Inhibition in Postmenopausal Women with Breast Cancer / 中国药师

Objective:To investigate the effect of anastrozole on sex hormone levels and michigan cancer foundation-7 ( MCF-7 ) cell inhibition in postmenopausal women with breast cancer. Methods: Totally 80 women with breast cancer were selected. Among them, 40 cases of patients received the routine management and tamoxifen treatment were included into the control group, and another 40 cases of patients received the routine management and anastrozole treatment were included into the observation group. The changes of sex hormone levels, effects and adverse drug reactions of two groups were compared between basetine and three months after treat-ment, meanwhile, the incidence of MCF-7 cell inhibition between two groups. Results:After treatment, the levels of estradiol( ER) , progesterone(PR) and luteotropic hormone(LH) were lower than baselime, however, the level of testosterone was contrary(P <0. 05). Meanwhile, the level of ER, PR and LH in control group were lower than baselime however, the level of testosterone was cont-ray (P<0. 05). The incidence of MCF-7 cell inhibillion between two grugs at time 72 h were higher than the 48 h, the incedence of MCF-7 cell inhibition in observation group were significantly higher than control groups at time 48 h and 72 h (P<0. 05). The rate of total effective in control group(45. 0%) was lower than the observation group(70. 0%)(P>0. 05). There was no significant differente in the micidence of adverse reactions. Conclusion:Anastrozole used for postmenopausal women with breast cancer has significant effi-cacy, high safety and promising inhibitory effect on MCF-7 cell. It can effectively adjust sex hormone level, reduce occurrence and transfer risks of breast cancer.

Metástasis duodenogástrica por cáncer de mama: reporte de caso / A Case Report of Duodenogastric Metastasis from Breast Cancer

Resumen Se presenta el caso de una mujer de 82 años con cáncer de mama diagnosticado en 2011 tratado con cirugía y adyuvancia hormonal con tamoxifeno. En 2015 fue hospitalizada por obstrucción intestinal alta y se descartó compromiso tumoral. Sin embargo, se realizó videotoracoscopia por presencia de derrame pleural y se documentaron lesiones pleurales correspondientes a metástasis. Se inició terapia hormonal con adecuada respuesta. Un año después, se realizó gastroduodenoscopia de control en la que se evidenció edema y eritema bulboduodenal. La biopsia corroboró compromiso metastásico por cáncer de mama.

Abstract We present the case of an 82 year old woman who was diagnosed with breast cancer in 2011 and who underwent surgery and adjuvant treatment with tamoxifen. In 2015 she was hospitalized for an upper intestinal obstruction. Involvement of a tumor was ruled out, but video-assisted thoracoscopy showed the presence of pleural effusion and pleural lesions corresponding to metastases. Hormone therapy was initiated, and the patient responded adequately. One year later, a gastroduodenoscopy showed edema and erythema of the duodenal bulb. The biopsy corroborated metastasis from breast cancer.

Clinical research of medical ovarian suppression combined with anastrozole in the treatment of metastatic breast cancer in premenopausal women / 肿瘤研究与临床

Objective To evaluate the correlation of the clinical effects and prognosis in patients receiving medical ovarian suppression (goserelin)combined with anastrozole treatment with premenopausal metastatic breast cancer.Methods 44 hormone dependent mastatic breast cancer patients were treated by goserelin,3.6mg hypodermic injection every 28 days and anastrozole 1 mg were administered orally,clinical effects and prognosis were analysed.Results The clinical benefit rates of goserelin combination with anastrozole in patients with metastatic breast cancer were 52.4 ％(23/44),and the median progression free survival (PFS)was 8.3(5.3-11.2)months.In the analysis of whether to accept chemotherapy,the PFS of the not received chemotherapy group was better than received chemotherapy group (16.9 months vs 5.8 months P=0.048).Conclusion The combination of goserelin and anastrozole is an effective endocrine therapy regiment for patients with premenopausal metastatic breast cancer.It can be recommended for the premenopausal and hormone dependent mastatic breast cancer patients.

Cost-Effectiveness Analysis of Adjuvant Hormonal Treatments for Women with Postmenopausal Hormone-Receptor Positive Early Breast Cancer in the Korean Context / 한국유방암학회지

PURPOSE: This study aims to evaluate the cost-effectiveness of two aromatase inhibitors for the adjuvant treatment of women with postmenopausal hormone receptor positive early breast cancer, and to find the most reasonable treatment option when the population is stratified by the nodal status. METHODS: A Markov model was developed with defining six Markov states based on breast cancer progression. The annual probabilities of recurrence by adjuvant treatment (anastrozole, letrozole, and tamoxifen) were estimated from the published studies in the overall population and in the node negative and node positive groups. The costs of the defined breast cancer events were measured by the micro-costing method based on the 2009 National Health Insurance Fee Schedule and the third Clinical Guideline of Breast Cancer Treatment. Anastrozole and letrozole were compared with tamoxifen respectively, using the same Markov model. The incremental cost-effectiveness ratios for the overall population and each subgroup were estimated. RESULTS: Anastrozole was more effective and costly than tamoxifen with anastrozole costing an additional Korean Won (KRW) 22,461,689 per quality-adjusted life year (QALY). Letrozole showed a similar incremental cost of KRW 21,004,142 per QALY. In the node negative group, anastrozole was the most cost-effective with an incremental cost of KRW 19,717,770 per QALY, while letrozole was the most cost-effective with an incremental cost of KRW 8,150,512 per QALY for the node positive group. The sensitivity analysis showed that these results were robust. CONCLUSION: The subgroup analysis clearly demonstrated which treatment was superior among the aromatase inhibitors in terms of the cost-effectiveness. Such a finding was not confirmed for the case of the overall population. The implication of this study is that the decision makers should be careful when generalizing the cost-effectiveness results. The stratified analysis in this context may help reach a reasonable decision for allocating medical resources.

Treatment of autonomous ovarian follicular cyst with long-term anastrozole therapy.

Functional follicular ovarian cysts are frequently reported in girls with peripheral precocious puberty (PP). These cysts are usually self-limiting and resolve spontaneously. Several drugs like antiestrogens (tamoxifen) and new aromatase inhibitors are seldom used for treatment. Here we report a girl with peripheral PP who presented with unilateral enlargement of the ovary and a recurrent autonomous ovarian cyst. No skin pigmentation or bone anomaly was noted. The patient was successfully treated with anastrozole, a highly selective aromatase inhibitor. No adverse reaction was noted. Anastrozole is a safe and tolerable drug especially used to suppress estrogen action.

Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early breast cancer in Brazil / Custo-efetividade do anastrozol em comparação com tamoxifeno no tratamento adjuvante do câncer de mama precoce no Brasil

OBJECTIVE: Breast cancer, a leading type of cancer in many developing countries, is the most frequent non-cutaneous tumor in Brazil. Hormone therapy is the standard of care in the adjuvant treatment of early-stage, hormone-receptor-positive disease, and both tamoxifen and third-generation aromatase inhibitors are options in postmenopausal women. The comparative cost-effectiveness of different treatment strategies is of considerable interest in societies facing limited resources. METHODS: In an attempt to compare cost-effectiveness of upfront treatment with tamoxifen or anastrozole, the medical and economic results in a hypothetical cohort of 64-year-old postmenopausal women, was analyzed considering the Brazilian healthcare system in 2005, the primary perspective of the private sector, and a lifetime horizon. Data from the ATAC Trial, Markov modeling, a modified Delphi panel, and microcosting (in Brazilian R$) were used to estimate costs and effectiveness of the two upfront strategies. RESULTS: The model estimated a gain of 0.55 discounted life-years for patients receiving anastrozole, relative to those treated with tamoxifen. With an incremental cost of R$ 15,141.15, the model estimated that the cost-effectiveness of anastrozole, in relation to tamoxifen, was R$ 27,326.80. Monte Carlo simulations showed that approximately 50 percent of the cases fell below the threshold of R$ 29,229.00 per life-year gained, which is recommended by the World Health Organization for Brazil. CONCLUSION: It was concluded that upfront anastrozole is a cost-effective option compared with tamoxifen in the adjuvant treatment of postmenopausal women with hormone-receptor-positive early breast cancer.

OBJETIVO: O câncer de mama, o mais comum em vários países desenvolvidos, é o tumor não cutâneo mais frequente no Brasil. A terapia hormonal é o tratamento adjuvante padrão para os estágios precoces, em doença com receptor hormonal positivo, e o tamoxifeno e os inibidores da aromatase de terceira geração são opções para mulheres na pós-menopausa. A comparação do custo-efetividade dos diferentes tratamentos é de grande interesse nas sociedades com limitações de recursos. MÉTODOS: Para comparar a custo-efetividade dos tratamentos com tamoxifeno ou anastrozol, foram analisados os resultados médicos e econômicos em uma coorte hipotética de mulheres com 64 anos de idade, considerando o sistema de saúde Brasileiro em 2005, sob a perspectiva do setor privado e o horizonte de tempo de uma vida. Usamos dados do Estudo ATAC, um modelo de Markov, um painel de Delphi modificado, e micro-costing (em reais R$) para estimar os custos e a efetividade das duas estratégias. RESULTADOS: O modelo estimou um ganho de 0.55 anos de vida descontados para pacientes recebendo anastrozol em relação àquelas tratadas com tamoxifeno. Com um custo marginal de R$ 15.141,15, o modelo estimou que o custoefetividade do anastrozol em relação ao tamoxifeno era de R$ 27.326,80. As simulações de Monte Carlo mostraram que aproximadamente 50 por cento dos casos estavam abaixo do limite de R$ 29.229,00 por ano-vida ganho, que é o recomendado pela Organização Mundial da Saúde para o Brasil. CONCLUSÃO: Nós concluímos que o anastrozol é uma opção custo-efetivo comparado ao tamoxifeno no tratamento adjuvante de câncer de mama precoce em mulheres na pós-menopausa com receptor de hormônio positivo.

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients / 부인종양

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.

The effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients / 부인종양

OBJECTIVE: To investigate the effect of adjuvant hormonal therapy on the endometrium and ovary of breast cancer patients. METHODS: A retrospective review was performed on the 207 patients who had taken tamoxifen or anastrozole, as adjuvant hormonal therapy after breast cancer surgery between January 2003 and December 2006. Gynecologic surveillance constituted of ultrasonographic exam of the endometrial thickness and ovarian cyst formation. The patients were classified into three groups and analyzed; premenopausal/postmenopausal women receiving tamoxifen and women receiving anastrozole. RESULTS: Mean duration of follow up was 20.6+/-6.6 months. There was no difference of mean endometrial thickness before hormonal therapy among the three groups (p=0.327). In women receiving tamoxifen, the endometrium was continuously thickened in proportion to the duration of the therapy irrespective of menopausal status while it remained unchanged in women receiving anastrozole (p<0.05). Endometrial biopsies were performed in 28 patients receiving tamoxifen. The most common histologic finding was proliferative endometrium in premenopausal women (7/21) and atrophic endometrium in postmenopausal women (6/7). There was no case of endometrial cancer in both groups. Ovarian cyst was found in 32 women and the most were developed in premenopausal women receiving tamoxifen (30/32). All of them showed benign nature on transvaginal ultrasonographic findings. CONCLUSION: Women undergoing adjuvant hormonal therapy after breast cancer surgery exhibited changes in the endometrium and ovary. However most changes were not a serious problem in this study and frequent gynecologic surveillance in these patients needs further investigation.

Management of adenomyosis in infertile women: comparison between laparotomic resection and administration of aromatase inhibitor (Experience in 55 cases).

The objective of this study was to observe the results of adenomyosis mangement with resection and administration of aromatase inhibitor. Cases of ademyosis in infertile women were collected for three years (January 1999 to December 2001) and the diagnoses were confirmed using transvaginal USG. Cases were grouped into two groups, i.e. group 1 (undergoing laparotomic resection) and group 2 (receiving treatment with aromatase inhibitor of anastrozole). Both groups were evaluated for changes in clinical symptoms, rate of successful pregnancy, and postoperative recurrency rate. During three years as many as 1619 infertility cases were managed, and among which 66 (4.07%) cases of adenomyosis were diagnosed with transvaginal USG. As many as 55 cases were analyzed, i.e., 32 cases underwent resection and 23 cases received aromatase inhibitor. Of 32 cases of surgical resection, the histopathological results showed 30 (93.75%) cases of adenomyosis and 2 (6.25%) cases of uterus myoma. In the group undergoing resection three cases (9.4%) were successfully pregnant, i.e., two cases had live birth, one case ended up with 6-week abortion. Moreover, 25 (78.1%) cases were not pregnant and 4 (12.5%) cases had recurrency, while 24 (75.35%) cases experienced disappearance of symptoms yet not pregnant. On the other hand, of 23 cases in the group receiving aromatase inhibitor 2 (8.6%) cases were able to be pregnant, one case had live birth and another case ended up with abortion, while 14 (59.1%) cases had disappearance of symptoms yet not pregnant. During three months of treatment with aromatase inhibitor, a reduction in the lesion size between 7.31 mm3 and 25.90 mm3 were observed with CI 95% (p < 0.001). In conclusion, treatment with aromatase inihibitor did not heal lesions, but only reduced the size of adenomyosis lesions. On the other hand, resection could heal lesions, yet recurrency of disease may occur (12.5%) after one postoperative year.