Adverse Effects Of Aromatase Inhibitors

Adjuvant hormonal therapy exposes otherwise healthy women to prolonged drug therapy, and determination of safety is therefore crucial. All of the adjuvant studies have closely examined the frequency of adverse effects of AIs, but only MA.17 has compared adverse effects in the AI group with those in the placebo group. Als are consistently associated with several short-term side-effects, including vasomotor instability and vaginal changes (21,28,39). In ATAC, the rate of withdrawal from treatment because of adverse effects was lower with AIs than with tamoxifen (11.1% vs. 14.3%, P = 0.0002) (20), suggesting that AIs may be better tolerated. Furthermore, an analysis in MA.17 has shown no decrement in quality of life among women taking letrozole as compared with those taking placebo (40). The rates of endometrial cancer and venous thromboembolic events in the AI-treated population remain consistently equal to or lower than those among women receiving tamoxifen (21,39). Currently, there are no comparative data on the frequency of adverse effects among the three AIs. MA.27, in which patients are randomized to treatment with anastrozole or exemestane, may begin to address this question. Several class-specific adverse effects of AIs deserve further exploration.

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