Breast Cancer Research and Treatment

, Volume 120, Issue 1, pp 127–134 | Cite as

Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study

  • Karine Briot
  • Michèle Tubiana-Hulin
  • Laurent Bastit
  • Ioana Kloos
  • Christian RouxEmail author
Clinical trial


The objective of the present study was to evaluate the effect of the switch of aromatase inhibitors (AIs) on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer. This was a 6-month, prospective, non-randomized, multicenter study. Patients who had discontinued anastrozole due to musculoskeletal symptoms were eligible to participate in this study, and received letrozole, which was initiated 1 month after anastrozole discontinuation. Musculoskeletal symptoms were systematically assessed for severity, location of the symptoms, presence of swelling and of morning stiffness by the oncologist patients when patients stopped taking their anastrozole, 1 month after the discontinuation of anastrozole, and 1, 3, and 6 months after initiating the letrozole therapy. The primary endpoint was the percentage of patients who discontinued letrozole due to the severe musculoskeletal symptoms. After switching from anastrozole therapy, and at the end of the 6-month letrozole treatment, 128 (71.5%) out of 179 patients (61.3 ± 8.4 years) continued with letrozole. Fifty-one patients (28.5%) discontinued treatment due to severe joint pain. At the end of the 6-month, 116 patients (73.9%) had arthralgia, 33 (21.0%) myalgia, 25 (15.9%) arthritis, 22 (14.0%) tendinitis, and 20 (12.7%) polyalgic syndrome. Bivariate analysis of the factors associated with letrozole discontinuation showed that the duration of a prior anastrozole treatment was a significant predictor (P = 0.04). This study shows that in patients intolerant to one AI, switching to another agent allows a higher proportion of patients to continue the therapy and maximize hormonal adjuvant therapy and disease outcome benefits.


Aromatase inhibitors Letrozole Musculoskeletal symptoms Postmenopausal breast cancer 



We thanks the investigators Drs the Dr Boniface-Gelas, Spaeth, Panis, Lucas, Yazbek, Bressac, Hardy-Bessard, Provencal, Fignon, Coeffic, De St Hilaire, Resbeut, Abadie, Krzich, Douadi-Gaci, Audrin, Abboud, Rotarski, Mercier Blas, Beatrix, Karst-Provost, Denis, Facchini, Azria, Mention, Campone, Laplaige, Cals, Delozier, Ellis, Mouysset, Pivot, Lecuru, Malaurie-Agostini, Meunier.

Conflict of interest statement

K Briot and C Roux received honoraria of Novartis. M Tubiana-Hulin has no conflict of interest to disclosure. L Bastit has no conflict of interest to disclosure. Ioana Kloos is medical oncologist, and an employee of Novartis


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Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Karine Briot
    • 1
  • Michèle Tubiana-Hulin
    • 2
  • Laurent Bastit
    • 3
  • Ioana Kloos
    • 4
  • Christian Roux
    • 1
    Email author
  1. 1.Rheumatology Department, Cochin Hospital, Rheumatology DepartmentParis Descartes UniversityParisFrance
  2. 2.René Huguenin InstituteSt CloudFrance
  3. 3.Frédéric Joliot CenterRouenFrance
  4. 4.NovartisRueil MalmaisonFrance

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