| Until recently tamoxifen occupied the central stage in | | | | inhibitors are currently FDA approved and available |
| adjuvant (post operative) hormonal treatment of | | | | for treatment of breast cancer. These drugs are |
| breast cancer. Tamoxifen has been the unchallenged | | | | anastrozole (Arimidex), letrozole (Femara) and |
| hormonal therapy of choice for adjuvant treatment | | | | exemestane (Aromasin). All these are active drugs |
| of early stage breast cancer for over two decades. | | | | are generally considered to be equally effective. |
| Things have changed now. A new group of hormonal | | | | Aromatase inhibitors may be useful even if a woman |
| drugs that has been introduced few years ago has | | | | has already been started on tamoxifen. Aromatase |
| almost replaced tamoxifen as the treatment of | | | | inhibitors can be taken for five years after |
| choice for early stage breast cancer. This new group | | | | completion of five years of tamoxifen. A clinical trial |
| of drugs known as aromatase inhibitors has been | | | | (MA-17) has shown that if Femara is taken for |
| shown to be more effective than tamoxifen over | | | | another extra five years after completion of five |
| and over again. | | | | years of treatment with tamoxifen, this would result |
| This new group of drugs however is not effective in | | | | in improved outcome. Other trials (ABCSG trial, ARNO |
| premneopausal women who have been diagnosed | | | | trial 95, and ITA trial) have shown that it is beneficial |
| with breast cancer. Tamoxifen still remains the | | | | to switch from tamoxifen to aromatase inhibitors |
| hormonal treatment of choice for women with | | | | after two to three years of treatment with |
| breast cancer who have hormone receptor positive | | | | tamoxifen. |
| early stage breast cancer. | | | | Aromatase inhibitors have already shown to be |
| This new group of drugs known as aromatase | | | | superior to tamoxifen in the treatment of hormone |
| inhibitors acts by inhibiting an enzyme called | | | | receptor positive metastatic (cancer that has spread |
| aromatase, which is responsible for production of | | | | to distant organs) breast cancer. In this situation |
| small amounts of estrogen in post-menopausal | | | | Femara is currently the drug of choice and tamoxifen |
| women. Estrogen production from the ovaries in | | | | have moved to second or third position as an option |
| premneopausal women is not depended on | | | | for hormonal therapy. |
| aromatase hormone, and that is the reason why this | | | | One thing is clear. The very foundation of tamoxifen |
| drug is not effective in premneopausal women. | | | | as the hormonal treatment of choice is shaking and |
| Three drugs belonging to the group of aromatase | | | | the aromatase inhibitors are here to stay. |