Long‐term effect of exemestane therapy on bone mineral density supported by bisphosphonates: Results of 5‐year adjuvant treatment in postmenopausal women with early‐stage breast cancer

Hirano, Akira; Inoue, Hiroaki; Ogura, Kaoru; Hattori, Akihiko; Yukawa, Hideki; Sakaguchi, Shiho; Matsuoka, Aya; Tanaka, Naoya; Kodera, Asaka; Kamimura, Mari; Naritaka, Yoshihiko; Shimizu, Tadao

doi:10.1111/ajco.13034

Cited by 3 publications

(2 citation statements)

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“…Real-world studies show that in terms of bone loss, steroidal AI is expected to be superior to nonsteroidal AI because steroids in bone would be favorable for bone metabolism. In an observational study, exemestane treatment maintained BMD of femoral neck (FN), suggesting that exemestane is favorable for BMD of FN [ 52 ]. The reason why steroidal AI induces less damage to FN compared with nonsteroidal AI is unknown, but steroidal AI might affect bone turnover directly through its structure.…”

Section: Discussionmentioning

confidence: 99%

“…Oesterreich et al [ 53 ] reported that urine N-telopeptide concentration was significantly increased in patients treated with exemestane but not in those treated with letrozole[ 54 ]. Another observational study in a real-world setting, conducted with everolimus plus exemestane in postmenopausal women with hormone receptor-positive, HER2-negative advanced BC showed that this combination had lower incidents of bone-related events [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

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Bone Safety Profile of Steroidal Aromatase Inhibitor in Comparison to Nonsteroidal Aromatase Inhibitors in Postmenopausal Women with Breast Cancer: A Network Meta-Analysis

Chen¹,

Lan²,

Lv³

et al. 2022

Breast Care

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Background and objectives: Aromatase inhibitors (AIs) provide an alternative to tamoxifen as adjuvant therapy for post-menopausal breast cancer (BC) patients. Large trials resulted better outcomes with AIs. Adjuvant therapy with AIs reduced risk of relapse than tamoxifen. Systemic therapies for BC can interfere with bone turnover, either through their effects on gonadal steroid hormone production or by inhibiting peripheral aromatization into estrogen. Comparative studies of AIs are lacking. We aimed to evaluate safety profile of bone related events by comparing three AIs against tamoxifen and placebo. Methods: PRSIMA guidelines were used for network meta-analyses. Searches were performed from PubMed, Embase/Medline, Cochrane, Ovid databases. Randomized controlled trials in BC patients treated with steroidal or non-steroidal AIs compared against tamoxifen and placebo or other AIs, with reported bone-related safety events were included. Network meta-analysis by Bayesian approach was performed by R software (ver 3.2), GemtC package. Results: 17 studies reporting 4 different bone-related endpoints were included. Treatment with exemestane lowered incidence of bone pain (odds ratio (OR) Vs anastrozole and letrozole: 0.63, 0.54), fracture episodes (OR Vs anastrozole and letrozole: 0.84, 0.80), and osteoporosis (OR) Vs anastrozole and letrozole: 0.85, 0.73) than letrozole and anastrozole, although there was no statistical significance. Reduction in bone mineral density was lesser in exemestane than anastrozole (mean reduction in hip: 1.05; lumbar spine: 1.25). Treatment ranking with the Surface Under the Cumulative ranking curve, exemestane was found to reduce incidence of bone-related adverse events. Conclusion: Lower incidence of bone-related safety events in patients treated with exemestane was observed. Further head-on studies are confirmation.

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Section: Discussionmentioning

confidence: 99%