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exemestane (Aromasin)
Indications:
1) treatment of advanced breast cancer in postmenopausal women with disease progression despite tamoxifen therapy [3]
2) 5 year disease-free survival in premenopausal women higher with exemestane than with tamoxifen (91.1% vs. 87.3%) [6]
3) prophylaxis for breast cancer in high-risk women [4]
- post-menopausal women with atypical ductal hyperplasia [4]
Dosage:
Storage:
- store in orginal container
Adverse effects:
- osteoporosis: increased bone loss [5]
- vasomotor symptoms
- arthragia
- headaches
- insomnia [8]
Clinical significance:
Clinical trial:
- 4742 women who had received 2-3 years of tamoxifen tamoxifen vs exemestane for an additional 2-3 years
- disease-free survival 87% (tamoxifen) vs 92% (exemestane)
- thromboembolic events less in exemestane group
- new cancers (non breast cancer) fewer in exemestane group
- no difference in mortality [2]
Interactions
drug adverse effects of aromatase inhibitors
General
antineoplastic endocrine agent
aromatase inhibitor
Properties
INHIBITS: cytochrome P450 19A1
Database Correlations
PUBCHEM cid=60198
References
- Kaiser Permanente Northern California Pharmacy update, 11/2000
- Journal Watch 24(7):58, 2004
Coombes RC et al, N Engl J Med 350:1081, 2004
PMID: 15014181
Piccart-Gebbart MJ, N Engl J Med 350:1040, 2004
- New Evidence Supports the Third-generation Aromatase Inhibitor
Exemestane (Aromasin) for Primary Breast Cancer
Prescriber's Letter 11(4):22 2004
Detail-Document#: 200408
(subscription needed) http://www.prescribersletter.com
- Goss PE et al
Exemestane for Breast-Cancer Prevention in Postmenopausal Women
N Eng J Med June 4, 2011
PMID: 21639806
http://www.nejm.org/doi/full/10.1056/NEJMoa1103507#t=articleTop
- Cheung AM et al
Bone density and structure in healthy postmenopausal women
treated with exemestane for the primary prevention of breast
cancer: a nested substudy of the MAP.3 randomised controlled
trial.
Lancet Oncol. 2012 Feb 6.
PMID: 22318095
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70389-8/abstract
- Cauley JA
Bone loss associated with prevention of breast cancer
Lancet Oncol. 2012 Feb 6.
PMID: 22318094
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2812%2970030-X/fulltext
- Pagani O et al
Adjuvant Exemestane with Ovarian Suppression in Premenopausal
Breast Cancer.
N Engl J Med. June 1, 2014
PMID: 24881463
http://www.nejm.org/doi/full/10.1056/NEJMoa1404037
- Prescriber's Letter 21(6): 2014
Oral Meds to Keep in Original Containers
Detail-Document#: 300622
(subscription needed) http://www.prescribersletter.com
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018