Supportive therapies ‘essential’ to mitigate aromatase inhibitor-related adverse effects
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Supportive therapies are necessary to help ensure patients adhere to aromatase inhibitor treatment, according to study results presented at San Antonio Breast Cancer Symposium.
Further study is necessary to assess the effect that age, race and ethnicity have on treatment duration and use of supportive management, researchers added.
“Patients who received at least one supportive therapy had increased rates of aromatase inhibitor adherence beyond 1 year compared with those who did not receive any supportive treatment,” Melanie W. Kier, MD, MBA, hematology-oncology fellow at Icahn School of Medicine at Mount Sinai, told Healio. “Our study demonstrates that supportive therapies are essential to help patients mitigate side effects of aromatase inhibitors and adhere to treatment.”
Aromatase inhibitors are standard for patients with early-stage hormone receptor-positive breast cancer.
However, these agents can cause significant adverse events, including musculoskeletal symptoms, hot flashes, virginal dryness and decreased bone density. These adverse events often lead patients to discontinue or change therapy.
“Aromatase inhibitors deplete circulating estrogens, and that loss of circulating estrogen is the cause of aromatase inhibitor-related toxicities,” Kier said. “Aromatase inhibitor-related [adverse] effects can limit tolerability and can affect patients’ ability to complete the recommended duration of therapy, which is at least 5 years and, for some patients, extended to 10 years to further improve outcomes. Aromatase inhibitor-related toxicities are the most common reason for poor adherence to therapy.”
Prior studies have demonstrated the efficacy of supportive management for mitigating adverse effects associated with aromatase inhibitor therapy. For example, acupuncture has been shown to reduce joint pain, and low-dose oxybutynin has helped mitigate hot flashes.
Kier and colleagues performed a retrospective chart review to assess the real-world use of supportive therapies for aromatase inhibitor-related toxicities over the past decade to determine if they had effects on patient adherence to initial aromatase inhibitor treatment.
The analysis included all female patients with early-stage hormone receptor-positive, HER2-negative breast cancer at Mount Sinai Health System who began adjuvant aromatase inhibitor therapy between January 2011 and February 2020.
Researchers used EMR data to collect information about patient demographics, aromatase inhibitor adverse effects, use of supportive therapies and duration of first aromatase inhibitor therapy. They also performed a manual chart review to verify data.
Rate of aromatase inhibitor discontinuation within 1 year among patients who used supportive therapies vs. those who did not served as the primary endpoint.
The analysis included 1,010 women. Forty-one percent of patients used supportive therapy and 59% did not.
Researchers determined 238 women discontinued aromatase inhibitor treatment within 1 year and 772 remained on treatment for 1 year or longer.
Among women who remained on treatment for at least 1 year, 47% had used supportive therapies and 53% had not. More than three-quarters of women who discontinued aromatase inhibitor treatment within 1 year did not utilize supportive therapy (79% vs. 21%).
Investigators determined use of supportive therapy significantly increased the likelihood that women would remain adherent to first aromatase inhibitor therapy for at least 1 year (OR = 0.29; 95% CI, 0.2-0.42).
“It was encouraging to see that patients who received at least one supportive therapy were more likely to remain on aromatase inhibitors,” Kier said. “It further supports the need to ensure supportive therapies are being offered to patients, as 91% of our patient population had aromatase inhibitor-related [adverse] effects yet only 41% received supportive therapies.”
Woman aged older than 50 years had a lower likelihood of discontinuation within 1 year than women aged 50 years or younger (OR = 0.35; 95% CI, 0.19-0.65). Compared with white women, 1-year discontinuation rates were significantly lower among Black or African American women (OR = 0.49; 95% CI, 0.3-0.77).
The majority (91%) of patients experienced adverse effects, the most common of which were musculoskeletal (56%), hot flashes (41%), osteoporosis (36%), osteopenia (32%) and vaginal dryness (20%). Forty-one percent of patients received supportive therapies, the most common of which were bone-strengthening agents and acupuncture.
Results showed comparable rates of adverse events reported among white (91%), Hispanic or Latino (91%), Black or African American (92%), and Asian women (92%). However, use of supportive therapy among Black or African American women (28%) appeared considerably lower than use among white (46%), Hispanic or Latino (41%), and Asian women (40%).
“Black or African American patients compared [with] white women had similar rates of aromatase inhibitor-related toxicities, but significantly lower incidence of supportive therapy usage. Despite their lower use of supportive therapies, Black or African American women had lower aromatase inhibitor 1-year discontinuation rates than white women.”
Further research is needed to better understand the reasons for this finding, Kier said.
“I am currently studying whether socioeconomic factors impact utilization of supportive therapy and aromatase inhibitor discontinuation rate,” Kier told Healio.
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Kier MW, et al. Abstract P5-18-11. Presented at: San Antonio Breast Cancer Symposium; Dec. 7-10, 2021; San Antonio.
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