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Selective estrogen receptor modulators reduced breast cancer risk up to 5 years
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Treatment with selective estrogen receptor modulators reduced breast cancer incidence by 38% among women at high risk for the disease, according to results of a meta-analysis.
Researchers observed the incidence reduction for up to 5 years after treatment.
Selective estrogen receptor modulators (SERM) are known to prevent diseases sensitive to estrogen, such as estrogen receptor-positive breast cancer.
D. Lawrence Wickerham
“The SERM meta-analysis paper again documents that these therapies are an effective method to reduce the risk of breast cancer and have a durable benefit that persists for years after the medications have been stopped,” researcher D. Lawrence Wickerham, MD, associate chairman of The National Surgical Adjuvant Breast and Bowel Project, told HemOnc Today. “None of the SERMs is perfect. They don’t prevent 100% of breast cancers and they all have some serious but uncommon side effects. We need to be able to better identify those women who will respond to SERMs, and those efforts are well under way.”
The US Preventive Services Task Force recently recommended shared decision-making between clinicians and women at risk for breast cancer regarding the use of risk-reducing medications for breast malignancies. That recommendation “reinforced that there are identifiable candidates for SERM therapy today,” Wickerham said.
Wickerham and colleagues conducted a meta-analysis that included data from nine prevention trials that compared tamoxifen, raloxifene, arzoxifene and lasofoxifene with placebo.
The analysis included 83,399 women. The incidence of all breast cancer types during 10 years of follow-up served as the primary outcome measure.
Researchers observed a larger decrease in breast cancer incidence during the first 5 years of follow-up (42%) compared with years 5 to 10 of follow-up (25%).
The risk for thromboembolic events were significantly increased for all selective estrogen receptor modulators (OR=1.73; 95% CI, 1.47-2.05). Although only a small effect was observed on non-vertebral fractures (OR=.93; 95% CI, 0.87-0.99), there was a significant decrease in vertebral fractures (OR=.66; 95% CI, .59-.73).
Researchers observed a 10% decrease in LDL cholesterol among patients assigned to selective estrogen receptor modulators. However, no overall decrease was observed in cardiovascular events.
The investigators noted that 42 women would need to be treated in order to prevent one breast cancer event during the first 10 years of treatment.
“The present study is a testament to the persistence of clinical trials groups, industry, investigators and women volunteers who have now collectively shown the long-term effectiveness of the original SERM hypothesis,” Anthony Howell, MD, and Gareth Evans, MD, both of Genesis Breast Cancer Prevention at the University Hospital of South Manchester, wrote in an accompanying editorial. “The future of breast cancer prevention will depend on prediction of breast cancer risk and responsiveness with more precision, improving the process by which patients are offered prevention, and developing drugs that prevent ER-negative breast cancer.”
For more information:
Cuzick J. Lancet. 2013;doi:10.1016/S0140-6736(13)60140-3.
Howell A.Lancet. 2013;doi:10.1016/S0140-6736(13)60443-2.
D. Lawrence Wickerham, MD, can be reached at larry.wickerham@nsabp.org.
Disclosure: Wickerham reports no relevant financial disclosures.