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Tamoxifen, Raloxifene , and Exemestane in the Chemoprevention of Breast Cancer

Tamoxifen, Raloxifene , and Exemestane in the Chemoprevention of Breast Cancer. By: Erin Hutzell. Background: Breast Cancer. Second leading cause of death due to cancer among women in 2007 1 in 3 women diagnosed with cancer is diagnosed with breast cancer Risk Factors Environmental

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Tamoxifen, Raloxifene , and Exemestane in the Chemoprevention of Breast Cancer

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  1. Tamoxifen, Raloxifene, and Exemestane in the Chemoprevention of Breast Cancer By: Erin Hutzell

  2. Background: Breast Cancer • Second leading cause of death due to cancer among women in 2007 • 1 in 3 women diagnosed with cancer is diagnosed with breast cancer • Risk Factors • Environmental • Genetic

  3. Background: Breast Cancer • Invasive VS. Noninvasive • Estrogen Receptor (ER) positive VS. Estrogen Receptor negative • Mechanism causing breast cancer

  4. Background: Chemoprevention and Drugs • Chemoprevention • What is it? • Tamoxifen • Selective Estrogen Receptor Modulator (SERM) • Raloxifene • SERM • Exemestane • Aromatase Inhibitor (AI)

  5. Questions • How effective is each drug in preventing breast cancer? • What are the side-effects of each drug treatment? • Which drug is the best possible chemopreventative measure for breast cancer?

  6. Tamoxifen * Modified from Grese et al 1997

  7. Tamoxifen • NSABP P-1 Study by Fisher et al (1998) • Subject Criteria • 60 years + • 35-59 years with predicted breast cancer risk • History of lobular carcinoma in situ or atypical hyperplasia • Methods • Control group • Tamoxifen group

  8. Tamoxifen • Supported By: • IBIS-I Study (Cuzick et al 2002) • Meta-analysis by Cuzick et al • Not Supported By: • Royal Marsden (Powles et al 1998) • Italian Tamoxifen Prevention Study (Veronesi et al 1998) * Kramer et al. 2004 Top: Fisher et al. 1998 Bottom: Fisher et al. 2005

  9. Tamoxifen • NSABP P-1 (Fisher et al 1998 and 2005) • Osteoporotic Fractures: REDUCED • Invasive Endometrial Cancer: RISK INCREASED • Supported by IBIS-I (Cuzick et al 2002) and Royal Marsden (Powles et al 1998) • Thromboembolic Events: RISK INCREASED • Supported by IBIS-I, Royal Marsden, and Italian Tamoxifen Prevention Study (Veronesi et al 1998) • Conclusion: Tamoxifen is an effective drug but has adverse side-effects * Kramer et al. 2004

  10. Exemestane http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60198

  11. Exemestane • Mammary Prevention.3 (MAP3) Trial by Goss et al (2011) • Subject Criteria • Postmenopausal Women • At least one risk factor • Methods • Exemestane • Placebo

  12. Exemestane • Conclusion: Exemestane is a more effective chemopreventative than Tamoxifen • Supported by: • Intergroup Exemestane Study by Bliss et al (2012) • Exemestane produced better disease-free survival * Goss et al 2011 Comparison of the risk reductions for Tamoxifen and Exemestane Table modified from Zhang et al. 2012

  13. Exemestane Comparison of the side-effects of Tamoxifen, Raloxifene, and Exemestane Table modified from Zhang et al. 2012

  14. Conclusion • Exemestane has the potential to be the best possible chemopreventative measure for breast cancer • Future: • Research Exemestane • Explore Medication Combinations • Demographics of Patients

  15. Bibliography

  16. Bibliography

  17. Questions?

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