Aromatase inhibitor-induced arthralgia: Clinical experience and treatment recommendations

Coleman, Robert E.; Bolten, W.; Lansdown, Mark; Dale, Stephen; Jackisch, Christian; Merkel, Douglas E.; Maass, Nicolaì; Hadji, Peyman

doi:10.1016/j.ctrv.2007.10.004

Cited by 114 publications

(101 citation statements)

References 39 publications

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“…Despite the established benefits of AI therapy on improving disease-free survival, AIs result in increased musculoskeletal symptoms compared to tamoxifen which may limit treatment persistence and long-term observance [9][10][11][12][13]. These effects must be anticipated, managed by non- Few studies have assessed the symptomatic effects of switching AIs on musculoskeletal symptoms in postmenopausal women with HR?…”

Section: Discussionmentioning

confidence: 99%

“…More recently, studies have revealed an increase in tenosynovial changes in women taking AIs compared to those on tamoxifen [11,12]. The mechanism of AI-associated musculoskeletal symptoms is unclear, and it is has been reported that increased pain sensitivity on nociceptive fibers may be due to estrogen deprivation at the cartilage and periarticular tissues [8,13]. Musculoskeletal symptoms can be severe, limiting normal daily activity and potentially lead to the discontinuation of an AI treatment.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

Briot

Tubiana-Hulin

Bastit

et al. 2009

Breast Cancer Res Treat

104

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To cite this version:Karine Abstract The objective of the present study was to evaluate the effect of the switch of aromatase inhibitors (AIs) on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer. This was a 6-month, prospective, non-randomized, multicenter study. Patients who had discontinued anastrozole due to musculoskeletal symptoms were eligible to participate in this study, and received letrozole, which was initiated 1 month after anastrozole discontinuation. Musculoskeletal symptoms were systematically assessed for severity, location of the symptoms, presence of swelling and of morning stiffness by the oncologist patients when patients stopped taking their anastrozole, 1 month after the discontinuation of anastrozole, and 1, 3, and 6 months after initiating the letrozole therapy. The primary endpoint was the percentage of patients who discontinued letrozole due to the severe musculoskeletal symptoms. After switching from anastrozole therapy, and at the end of the 6-month letrozole treatment, 128 (71.5%) out of 179 patients (61.3 ± 8.4 years) continued with letrozole. Fifty-one patients (28.5%) discontinued treatment due to severe joint pain. At the end of the 6-month, 116 patients (73.9%) had arthralgia, 33 (21.0%) myalgia, 25 (15.9%) arthritis, 22 (14.0%) tendinitis, and 20 (12.7%) polyalgic syndrome. Bivariate analysis of the factors associated with letrozole discontinuation showed that the duration of a prior anastrozole treatment was a significant predictor (P = 0.04). This study shows that in patients intolerant to one AI, switching to another agent allows a higher proportion of patients to continue the therapy and maximize hormonal adjuvant therapy and disease outcome benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

Briot

Tubiana-Hulin

Bastit

et al. 2009

Breast Cancer Res Treat

104

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“…AIMSS adversely impacts on the quality of life of many patients. Studies recently investigating AIMSS have shown incidence of musculoskeletal symptoms to be as much as 50% (8)(9)(10), higher than the pivotal aromatase inhibitor trials with rates of approximately 20-35% (11)(12)(13). The prevalence of musculoskeletal symptoms impacts the long-term care of these patients.…”

Section: Introductionmentioning

confidence: 98%

Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis

Roberts

Rickett

Greer

et al. 2017

Critical Reviews in Oncology/Hematology

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“…ER-a and b are found in normal cartilage, but are present at increased levels in osteoarthritic joints [29,30]. Type II collagen (CTX-II), the main structural protein of articular cartilage, may be influenced by oestrogen.…”

Section: Role Of Oestrogenmentioning

confidence: 99%

“…Early age was another factor predicting an early onset of joint symptoms (9.8 months in the \60 years subgroup). This may be explained partly by the fact that younger patients are more likely to receive chemotherapy [29,43]. Only a small number of patients withdrew from therapy (A 2.1%, T 0.9%) [43,44].…”

Section: Upfront Usementioning

confidence: 99%

Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more?

Din

Dodwell

Wakefield

et al. 2010

Breast Cancer Res Treat

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Aromatase inhibitors (AIs) are a standard of care for the adjuvant treatment of hormone responsive early carcinoma of the breast as demonstrated in a number of large international phase III randomised trials. Arthralgia was a somewhat unexpected side effect of this class of agents and has proven to be potentially problematic in clinical practice. Although rates of up 35% have been reported in the randomised trials, the figure has been much higher in subsequent case series. There is concern that these symptoms are significant and may affect compliance and thus the overall efficacy of treatment. It is therefore extremely important that we evaluate this syndrome with a view to gaining more information regarding its clinical features and possible aetiological mechanism. The potential aetiological mechanisms and evidence for aromatase inhibitor-induced arthralgia (AIA) are reviewed in this article. Looking forward, it is now important that prospective clinical trials are well designed to evaluate this syndrome and potential therapeutic strategies to circumvent it. Radiological imaging and biochemical analyses may help our understanding of AIA and these are discussed.

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Aromatase inhibitor-induced arthralgia: Clinical experience and treatment recommendations

Cited by 114 publications

References 39 publications

Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis

Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more?

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