Estrogen is the main hormone involved in the development and growth of breast tumors; oophorectomy was first shown to cause regression of advanced breast cancer more than a century ago, 18 and estrogen deprivation remains a key therapeutic approach. 19
The CIRAS Study: A case control study to define C linical, I mmunologic, and R adiographic features of the aromatase inhibitor A rthalgia S yndrome October Research Noon Conference James McCloskey
Mortality rate among women with breast cancer has continually decreased since the 1990’s with earlier detection, thorough screening, increased awareness, and advances in treatment. From Jemal, A. et al. CA Cancer J Clin 2009;59:225-249.
Letrozole significantly decreased the risk of reoccurrence compared to tamoxifen.
Especially at Distant sites.
The BIG 1-98 Group. NEJM 2005:353:2747 Copyright 2005 NEJM
Combination AI and Tamoxifen Therapy Results are shown for letrozole monotherapy as compared with tamoxifen followed by letrozole (Panels A) and for letrozole monotherapy as compared with letrozole followed by tamoxifen (Panels B). Letrozole monotherapy is as efficient as combination letrazole and tamoxifen therapy. The BIG 1-98 Collaborative Group. 2009. NEJM; 361:766-776 Copyright 2009 NEJM
Stage I-III post-menopausal breast cancer patients followed at Lombardi Cancer Center with hand pain Receiving Aromatase Inhibitor CASES (n=24) Not Receiving Aromatase Inhibitor CONTROLS (n=24) RHEUMATOLOGIC EVALUATION (1 hour) History and Physical Examination by rheumatologist DAS-28 joint examination (completed by rheumatologist) QUESTIONNAIRES (30 minutes): Health Assessment Questionnaire (completed with GCRC staff) BLOOD TESTS(30 minutes): Autoantibody screen: RF, CCP, ANA Inflammatory Markers: ESR, CRP Bone markers: 25-OH Vitamin D Study biomarkers: TNF-α, IL-6 IMAGING (1hour 30 minutes): Hand X-Ray (30 minutes) Hand Ultrasound (1 hour) Eligibility assessed, study discussed with patient, and obtain consent. Schedule Study visit: (note all investigators blinded except recruiting team) PATIENTS MUST ABSTAIN FROM NSAIDS FOR 48 HOURS PRIOR TO ULTRASOUND Follow-up telephone call with Dr. Shanmugam to discuss results and if necessary arrange follow-up Study Schema
American Cancer Society Cancer Facts and Figures 2009. http://www.cancer.org/downloads/STT/500809web.pdf
ATAC Trialists' Group. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 2005;365:60-62.
BIG 1-98 Collaborative Group. Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med. 2009 Aug 20;361(8):766-76.
Burnstein, H. Aromatase inhibitor-associated arthalgia syndrome. The Breast 2007; 16:223-234.
Crew, KD, Greenlee H, Capodice J, et al. Prevalence of Joint Symptoms in Postmenopausal Women Taking aromatase inhibitors for early stage breast cancer. J Clin Oncology 2007; 25:3877-83.
Felton DT, Cumming ST. Aromatoase Inhibitors and the syndrome of arthalgias with estrogen depravation. Arthritis &Rheumatism 2005; 52: 2594-8.
Goss PE, Ingle JN, Martino S, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 2005;97:1262-1271.
Jemal, A. et al. ACS facts and figures 2009. CA Cancer J Clin 2009;59:225-249
Morales et al. Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on. Breast Cancer Res Treat. 2007 Jul;104(1):87-91.
Partridge, AH et al. Adherance to intial adjuvan anastrozole therapy among women with early stage breast cancer. J Clin Oncology 2008; 26:556-62.
Singh S, Vitamin D levels among patients with arthalgias: results from IBIS- II breast cancer prevention study. San Antonio Breast Cancer Symposium, San Antonio, TX 2006.
Smith IE, Dowsett M. Aromatase inhibitors in breast cancer. N Engl J Med 2003;348:2431-2442 .
Adjuvant tamoxifen has been the mainstay of adjuvant endocrine therapy for decades for woman with early stage hormone receptor positive breast cancer.
The addition of aromatase inhibitors in post-menopausal women with hormone responsive breast cancer, as either initial therapy or after a 2-3 year period of tamoxifen therapy has been shown to decrease reoccurrence rates by 13-40%.
The incorporation of AIs is now considered standard of care therapy.