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Description
Aromasin is the brand name for the medication exemestane, which belongs to a class of drugs known as aromatase inhibitors. It is primarily used in the treatment of hormone receptor-positive breast cancer in postmenopausal women. Aromasin works by inhibiting the enzyme aromatase, which is responsible for converting androgens (such as testosterone) into estrogen. By blocking aromatase activity, Aromasin reduces estrogen levels in the body, which can slow or stop the growth of hormone-sensitive breast cancer cells.
Medical Use: Aromasin is approved for the adjuvant treatment of early-stage hormone receptor-positive breast cancer in postmenopausal women who have undergone surgery, chemotherapy, or radiation therapy. It is also indicated for the treatment of advanced breast cancer that has progressed following tamoxifen therapy or other hormonal treatments. Aromasin is often prescribed as part of a comprehensive treatment plan to reduce the risk of cancer recurrence and improve overall survival.
Estrogen Suppression: Breast cancer cells that are hormone receptor-positive rely on estrogen to grow and proliferate. Aromasin works by inhibiting aromatase, the enzyme responsible for estrogen synthesis in peripheral tissues such as adipose (fat) tissue and the adrenal glands. By reducing estrogen levels in the body, Aromasin helps deprive cancer cells of the estrogen they need to thrive, thereby slowing or halting tumor growth.
Hormone Replacement Therapy (Off-label): In addition to its use in breast cancer treatment, Aromasin is sometimes used off-label as part of hormone replacement therapy (HRT) in postmenopausal women with estrogen deficiency. It may be prescribed to alleviate symptoms of menopause such as hot flashes, vaginal dryness, and bone loss. However, Aromasin is not approved for this indication, and its use for HRT should be carefully considered based on individual risk factors and hormone levels.
Side Effects: Common side effects of Aromasin include hot flashes, joint pain, fatigue, headache, nausea, and weakness. Long-term use of Aromasin may increase the risk of osteoporosis and bone fractures due to decreased estrogen levels. Rare but serious side effects may include liver problems, allergic reactions, and an increased risk of cardiovascular events such as heart attack and stroke. It is essential to discuss the potential risks and benefits of Aromasin with a healthcare professional before starting treatment.
Drug Interactions: Aromasin may interact with certain medications, including estrogen-containing therapies, tamoxifen, and medications that affect liver function. It is important to inform your healthcare provider about all medications, supplements, and herbal products you are taking before starting Aromasin.
Overall, Aromasin is an effective and well-tolerated medication for the treatment of hormone receptor-positive breast cancer in postmenopausal women. It offers a targeted approach to reducing estrogen levels in the body, helping to slow or stop the progression of breast cancer and improve outcomes for patients. However, like all medications, Aromasin should be used as prescribed and under the supervision of a qualified healthcare professional.
Aromasin (Exemestane) Vs. Arimidex (Anastrozole)
Aromasin (exemestane) and Arimidex (anastrozole) are both aromatase inhibitors used in the treatment of hormone receptor-positive breast cancer in postmenopausal women. While they belong to the same class of medications and share similar mechanisms of action, there are some differences between the two drugs in terms of efficacy, side effects, and dosing.
Mechanism of Action:
Aromasin (Exemestane): Aromasin irreversibly inhibits the aromatase enzyme, which is responsible for converting androgens into estrogen. By blocking aromatase activity, Aromasin reduces estrogen levels in the body.
Arimidex (Anastrozole): Arimidex reversibly inhibits aromatase, leading to a reduction in estrogen synthesis. It also lowers estrogen levels by inhibiting the conversion of androgens to estrogen.
Efficacy:
Both Aromasin and Arimidex are effective in reducing estrogen levels and suppressing the growth of hormone receptor-positive breast cancer cells. Clinical studies have shown that both drugs are similarly effective as adjuvant therapy in postmenopausal women with early-stage breast cancer.
The choice between Aromasin and Arimidex may depend on individual patient factors, treatment history, and tolerability.
Side Effects:
Aromasin and Arimidex have similar side effect profiles, including hot flashes, joint pain, fatigue, headache, nausea, and weakness. Long-term use of both medications may increase the risk of osteoporosis and bone fractures due to decreased estrogen levels.
However, some patients may tolerate one medication better than the other, and individual responses to treatment may vary.
Dosage and Administration:
Aromasin is typically administered orally once daily, usually at a dose of 25 mg.
Arimidex is also taken orally once daily, typically at a dose of 1 mg.
Cost and Availability:
The cost of Aromasin and Arimidex may vary depending on factors such as insurance coverage, generic availability, and pharmacy pricing.
Both medications are available by prescription and are widely used in the treatment of hormone receptor-positive breast cancer.
Overall, Aromasin and Arimidex are both effective options for the treatment of hormone receptor-positive breast cancer in postmenopausal women. The choice between the two drugs may depend on factors such as individual patient characteristics, side effect profiles, and cost considerations. It is essential to discuss treatment options with a healthcare provider to determine the most appropriate therapy for each patient.
Aromasin for Women at High Risk of Developing Breast Cancer
Women with a strong family history of breast cancer and women who carry the BRCA1 and BRCA2 genes are at an increased risk of developing breast cancer and may opt to take more aggressive preventive measures, including the use of "chemoprevention", or drugs that block the effects of estrogen-because estrogen causes some cancers to grow. There are two types of drugs used to block estrogen. Selective estrogen receptor modulators (SERMs) are drugs that block estrogen receptors within the breast cells, thereby reducing estrogen-stimulated growth. Tamoxifen and Evista® (raloxifene) are examples of SERMs. Aromatase inhibitors suppress the production of estrogen in postmenopausal women. Aromasin is an aromatase inhibitor. Each of these drugs has been shown to reduce the risk of breast cancer in women at high risk of the disease.
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To evaluate Aromasin for breast cancer prevention in high-risk women, researchers conducted a Phase III trial among 4,560 postmenopausal women. The women had at least one of these breast cancer risk factors:
age greater than 60
five-year risk of breast cancer of more than 1.66% based on the Gail score
prior atypical ductal or lobular hyperplasia, lobular carcinoma in situ, or ductal carcinoma in situ with mastectomy. Study participants received either Aromasin or a placebo.
Risk of invasive breast cancer was 65% lower among women in the Aromasin group than among women in the placebo group. There were 11 invasive breast cancers in the Aromasin group and 32 invasive breast cancers in the placebo group.
Symptoms such as hot flashes, fatigue, sweating, insomnia, and joint pain were common among all study participants, but slightly more so among women treated with Aromasin.
These results suggest that Aromasin may be safe and effective when used to reduce the risk of breast cancer in high-risk women.
Recommendation guidelines from ASCO are as follows:
For premenopausal women:
The use of tamoxifen (20 mg per day orally for 5 years) should be discussed as an option to reduce the risk of invasive, estrogen receptor (ER)-positive breast cancer
For postmenopausal women:
There are now three options. ASCO strongly recommends that one of the following be considered in order to reduce the risk of invasive, estrogen receptor (ER)-positive breast cancer: Tamoxifen (20 mg per day orally for 5 years) Evista (60 mg per day orally for 5 years) Aromasin (25 mg per day orally for 5 years). (Note: This is a new recommendation, which was based on data from a clinical trial that showed up to a 70 percent reduction in overall and ER-positive invasive breast cancer incidence compared to placebo.)
What's more, the recommendations state that all three agents should be discussed with women aged 35 or older without a personal history of breast cancer who are at increased risk of developing invasive breast cancer, based on risk factors such as age, race, and medical and reproductive history.
Not all women will benefit from the use of these preventive agents. It is important that doctors and women discuss the risks and benefits of each drug in order to determine the best approach. That said, only a small percentage of eligible women have this discussion with their doctors or even consider these medications. As such, the guidelines also stress the need for ongoing research to determine approaches to increase the use of these drugs in women who will benefit from them. (14)
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