First-line endocrine treatment of breast cancer: aromatase inhibitor or antioestrogen?

During the study period, it was not possible to reach a robust estimate of OS given the immaturity of data and therefore additional follow-up is needed. In terms of safety, the proportion of patients discontinuing treatment due to AEs was aligned with PALOMA-2 (10.7% vs 12.2%) 10, even though higher than reported elsewhere 15. The most common AE reported in PALOMA-2 and in subsequent real-world studies was neutropenia, described to occur in around 60% of cases 10, 15, 16. In our study, however, even though we found a lower proportion of neutropenia, 42.9%, all of them led to treatment discontinuation. These differences are likely to result from a stricter protocol for recording AEs in clinical trials 10 and the greater exhaustiveness of AEs in retrospective chart reviews compared to disease registries 28.

Side effects of aromatase inhibitors

Economic evaluation is an essential part of the health technology assessment (HTA) process to help inform healthcare decision-makers. The quality of these studies is crucial to countries with limited HTA resources. This review will help authors from such countries to improve the quality of their studies so that policymakers will have the tools to help them make better decisions. We systematically reviewed the economic evaluation of AIs since 2010, examined the quality of these studies, and summarized the evidence on drivers of cost-effectiveness.

Combining AIs and antioestrogens with a second signal transduction inhibitor to prevent or even reverse endocrine therapy resistance is now under investigation. Combining endocrine therapy with the rational use of these agents may be our best hope for more dramatic advances in the treatment of this common disease. The ICERs from the 18 published analyses appear to be generally consistent with other cost-effectiveness analyses of breast cancer related interventions. A systematic review identified 89 cost-effectiveness analyses for breast cancer related interventions with a median ICUR of $27 K (2008 USD $/QALY).

Two other randomized controlled trials (108, 109) investigated the feasibility of employing simple text messaging technology to limit the early discontinuation of breast cancer endocrine therapy. The first study found that a biweekly unidirectional message sent to patients undergoing endocrine treatment for 36 months did not affect adherence compared with usual care. This finding was perhaps because the project did not actively engage patients and was insufficient to produce a behavioral change (108). The app communicated the onset of adverse symptoms and AI adherence through built-in alerts sent to the patient’s care team.

In postmenopausal women, whose ovaries are no longer functioning, the peripheral tissues are the predominant source of estrogen. One study did not extrapolate beyond the time horizon of the trial data used in construction of the model. There is growing concern over the ability, even in high income countries, to deliver affordable cancer care.

• For example, a systematic review of the literature demonstrated that for older patients mortality rates can increase more than five-fold in the three months following hip fracture and an elevated risk of death lasts for many years.
• To evaluate the effectiveness and safety of aromatase inhibitors (AIs) in women with uterine fibroids.
• They block the CYP19A1 chain by inhibiting its active site, resulting in loss of electron transfer.
• 60, 61 For example, Polyzos et al demonstrated that industry-sponsored CEAs assessing cervical cancer screening were more likely to exclude data sources presenting favourable results for existing technologies.
• The use of AIs in the treatment of endometriosis was based on the evidence of aromatase activity in ectopic endometrial lesions, and the relationship between the presence of extrauterine endometrial tissue and serum oestrogen levels.

It is https://www.isummersoft.com/growth-hormone-method-of-application-2/ increasingly recognized that the financial burden from health care costs results in patient distress. The Centers for Disease Control and Prevention estimates that one in three persons is in a family that experiences the financial burden of cancer care, and one in ten is in a family that has health care–related bills that they are not able to pay (39). As a result, increased attention has been paid to the financial toxicity of oncologic treatments.

Drug adherence: new approaches to connected solutions

Moisturizers can provide the function of physiologic vaginal secretions, and lubricants can decrease friction during sexual intercourse (Biglia et al., 2015; Moegele et al., 2012). However, the clinical benefit of these therapies is limited, and the prevention and management of GSM is largely unsolved (Biglia et al., 2015; Cook et al., 2017). Two reviewers (AJB, WW) performed data abstraction and quality appraisal, with disagreements resolved through consultation with a third reviewer (CB). However, there has been controversy about the importance of endogenous oestrogens to cardiovascular risk, because age and menopause are closely related and lipid profiles change with age. G.S.S. reports institutional research support from Agendia, AstraZeneca, Merck, Novartis, Roche and Seagen; and consultancy for Biovica, Novartis and Seagen.

Aromatase activity is significantly stimulated by a cyclic adenosine monophosphate (cAMP) analogue, prostaglandin E2 (PGE2), or by a combination of a glucocorticoid and a cytokine (interleukin (IL)‐1) (Bulun 1994; Han 2008; Shozu 2002; Sumitani 2000). Aromatase mRNA has been detected in more than 90% of fibroids (Bulun 1994) but was undetectable in myometrial tissues from disease‐free uteri. Ishikawa et al found that leiomyoma tissues from African American women contained the highest levels of aromatase expression, which may result in elevated tissue concentrations of oestrogen and may account for their higher prevalence and earlier incidence (Ishikawa 2009). Aromatase inhibitors are not effective in premenopausal women unless they are combined with ovarian suppression because they mainly inhibit the estrogen produced in the fat tissue and not in the ovaries. The primary source of estrogen prior to menopause are the ovaries (not the peripheral conversion of androgens to estrogen by aromatase as in postmenopausal women). This is a narrative review of a topic on which a very limited amount of literature exists.

Study participants

The appraisal committee (section 5) considered evidence submitted by Eli Lilly and a review of this submission by the evidence review group (ERG). According to the National Law, it is foreseen that patient data are registered under a National database, mandatory for all hospitals treating cancer in Portugal, and consents publication of data in an anonymized and aggregated compiled format 30. Considering the current post-marketing HTA model in Portugal, the development of a study with real-world data was necessary to provide evidence that could inform final reimbursement decision. Results of bone mineral densitometry in the subgroups of patients divided by the timing of the performance of the radiological exam. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.