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Drug switch because of treatment-related adverse side effects in endocrine adjuvant breast cancer therapy: how often and how often does it work?

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Abstract

Therapy-related adverse side effects are a main reason for non-persistence to adjuvant endocrine breast cancer therapy. This study reports frequency of drug-related adverse side effects that were so severe that a modification of the therapy was necessary. We evaluated how many patients discontinued adjuvant endocrine therapy because of these side effects (non-persistence). Last, we analyzed how often a drug switch was undertaken for this reason and how often this measure led to the patient successfully continuing their endocrine therapy. Data concerning all postmenopausal breast cancer patients (≤80 years), who initiated endocrine adjuvant therapy between 1998 and 2008 in a Swiss breast center (n = 400), were analyzed. Out of these 400 women, 37 (9.3%) were defined as being non-persistent to the therapy; out of these, 24 (64.9%) because of therapy-related side effects. About 78 patients (19.5%) suffered from severe therapy-related side effects that made a modification of therapy necessary. Out of these 78 cases, 14 patients (17.9%) stopped the therapy without attempting a drug switch (non-persistence). In 64 patients (82.1%; 16% of all women who started endocrine therapy), a drug switch was undertaken. Out of these 64 cases, in 52 cases (81.3%) endocrine therapy was completed after therapy modification. Patients who reported one major adverse effect were more likely to continue the endocrine therapy after a drug switch (P = 0.048) compared with those who suffered from at least two different side effects. In 10 of the 64 cases (15.6%), modification of the therapy was not successful and the patients stopped the treatment prematurely (non-persistence) because of ongoing side effects. In cases when therapy-related side effects occur, a drug switch is a promising step to further improve persistence and, by doing so, the outcome of breast cancer patients.

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References

  1. Goldhirsch A, Glick JH, Gelber RD, Senn HJ (1998) Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. J Natl Cancer Inst 90(21):1601–1608

    Article  PubMed  CAS  Google Scholar 

  2. Cella D, Fallowfield LJ (2008) Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer Res Treat 107(2):167–180

    Article  PubMed  CAS  Google Scholar 

  3. Dent SF, Gaspo R, Kissner M, Pritchard KI (2011) Aromatase inhibitor therapy: toxicities and management strategies in the treatment of postmenopausal women with hormone-sensitive early breast cancer. Breast Cancer Res Treat 126(2):295–310

    Article  PubMed  CAS  Google Scholar 

  4. Hadji P (2010) Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy. Crit Rev Oncol Hematol 73(2):156–166

    Article  PubMed  Google Scholar 

  5. Monnier A (2007) Clinical management of adverse events in adjuvant therapy for hormone-responsive early breast cancer. Ann Oncol 18(Suppl 8):36–44 viii

    Google Scholar 

  6. Mortimer JE (2010) Managing the toxicities of the aromatase inhibitors. Curr Opin Obstet Gynecol 22(1):56–60

    Article  PubMed  Google Scholar 

  7. Mouridsen HT (2006) Incidence and management of side effects associated with aromatase inhibitors in the adjuvant treatment of breast cancer in postmenopausal women. Curr Med Res Opin 22(8):1609–1621

    Article  PubMed  CAS  Google Scholar 

  8. Massacesi C, Zepponi L, Rocchi M, Rossini S, Burattini L (2006) Tamoxifen-related endocrine symptoms in early breast cancer patients are relieved when it is switched to anastrozole. J Clin Oncol 24(18S June 20 Supplement):10597

  9. Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A (eds) (2009) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  10. Sobin L, Gospodarowicz M, Wittekind C (eds) (2009) UICC: TNM classification of malignant tumors, 7th edn. Wiley–Blackwell, Oxford

    Google Scholar 

  11. Guth U, Huang DJ, Schotzau A, Zanetti-Dallenbach R, Holzgreve W, Bitzer J, Wight E (2008) Target and reality of adjuvant endocrine therapy in postmenopausal patients with invasive breast cancer. Br J Cancer 99(3):428–433

    Article  PubMed  CAS  Google Scholar 

  12. Partridge AH, LaFountain A, Mayer E, Taylor BS, Winer E, Asnis-Alibozek A (2008) Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol 26(4):556–562

    Article  PubMed  CAS  Google Scholar 

  13. Partridge AH, Wang PS, Winer EP, Avorn J (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21(4):602–606

    Article  PubMed  CAS  Google Scholar 

  14. Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15(8):565–574 Discussion 575–567

    Article  PubMed  Google Scholar 

  15. Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109(5):832–839

    Article  PubMed  CAS  Google Scholar 

  16. Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497

    Article  PubMed  CAS  Google Scholar 

  17. Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Colleoni M et al (2007) Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. J Clin Oncol 25(5):486–492

    Article  PubMed  CAS  Google Scholar 

  18. Coombes RC, Hall E, Gibson LJ, Paridaens R, Jassem J, Delozier T, Jones SE, Alvarez I, Bertelli G, Ortmann O et al (2004) A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350(11):1081–1092

    Article  PubMed  CAS  Google Scholar 

  19. Fisher B, Costantino J, Redmond C, Poisson R, Bowman D, Couture J, Dimitrov NV, Wolmark N, Wickerham DL, Fisher ER et al (1989) A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320(8):479–484

    Article  PubMed  CAS  Google Scholar 

  20. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M et al (2008) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 9(1):45–53

    Article  PubMed  Google Scholar 

  21. Atkins L, Fallowfield L (2006) Intentional and non-intentional non-adherence to medication amongst breast cancer patients. Eur J Cancer 42(14):2271–2276

    Article  PubMed  Google Scholar 

  22. Demissie S, Silliman RA, Lash TL (2001) Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women. J Clin Oncol 19(2):322–328

    PubMed  CAS  Google Scholar 

  23. Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA (2004) Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor–positive breast cancer. J Clin Oncol 22(16):3309–3315

    Article  PubMed  Google Scholar 

  24. Grunfeld EA, Hunter MS, Sikka P, Mittal S (2005) Adherence beliefs among breast cancer patients taking tamoxifen. Patient Educ Couns 59(1):97–102

    Article  PubMed  Google Scholar 

  25. Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Lin Gomez S, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28(27):4120–4128

    Article  PubMed  Google Scholar 

  26. Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99(2):215–220

    Article  PubMed  Google Scholar 

  27. Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Yood MU et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol 26(4):549–555

    Article  PubMed  Google Scholar 

  28. Silliman RA, Guadagnoli E, Rakowski W, Landrum MB, Lash TL, Wolf R, Fink A, Ganz PA, Gurwitz J, Borbas C et al (2002) Adjuvant tamoxifen prescription in women 65 years and older with primary breast cancer. J Clin Oncol 20(11):2680–2688

    Article  PubMed  Google Scholar 

  29. Waterhouse DM, Calzone KA, Mele C, Brenner DE (1993) Adherence to oral tamoxifen: a comparison of patient self-report, pill counts, and microelectronic monitoring. J Clin Oncol 11(6):1189–1197

    PubMed  CAS  Google Scholar 

  30. Ziller V, Kalder M, Albert US, Holzhauer W, Ziller M, Wagner U, Hadji P (2009) Adherence to adjuvant endocrine therapy in postmenopausal women with breast cancer. Ann Oncol 20(3):431–436

    Article  PubMed  CAS  Google Scholar 

  31. Chlebowski RT, Geller ML (2006) Adherence to endocrine therapy for breast cancer. Oncology 71(1–2):1–9

    PubMed  CAS  Google Scholar 

  32. Mallinger JB, Griggs JJ, Shields CG (2005) Patient-centered care and breast cancer survivors’ satisfaction with information. Patient Educ Couns 57(3):342–349

    Article  PubMed  Google Scholar 

  33. Stewart M, Brown JB, Hammerton J, Donner A, Gavin A, Holliday RL, Whelan T, Leslie K, Cohen I, Weston W et al (2007) Improving communication between doctors and breast cancer patients. Ann Fam Med 5(5):387–394

    Article  PubMed  Google Scholar 

  34. Hadji P (2008) Menopausal symptoms and adjuvant therapy-associated adverse events. Endocr Relat Cancer 15(1):73–90

    Article  PubMed  CAS  Google Scholar 

  35. Vicary P, Johnson M, Maher J (2007) To my oncologist: an open letter from a patient at the end of follow-up. Clin Oncol (R Coll Radiol) 19(10):746–747

    CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that there are no financial or personal relationships with other people or organizations that could inappropriately influence the work reported or the conclusions, implications, or opinions stated.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, 4031, Basel, Switzerland

    Uwe Güth, Mary Elizabeth Myrick, Nerbil Kilic & Seraina Margaretha Schmid

  2. Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Uwe Güth, Nerbil Kilic & Seraina Margaretha Schmid

  3. Department of Gynecology and Obstetrics, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Uwe Güth

  4. Schötzau & Simmen Institute for Biomathematics, Malzgasse 9, 4052, Basel, Switzerland

    Andreas Schötzau

  5. Department of Oncology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Nerbil Kilic

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  1. Uwe Güth
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  2. Mary Elizabeth Myrick
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  3. Andreas Schötzau
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  5. Seraina Margaretha Schmid
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Correspondence to Uwe Güth.

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Güth, U., Myrick, M.E., Schötzau, A. et al. Drug switch because of treatment-related adverse side effects in endocrine adjuvant breast cancer therapy: how often and how often does it work?. Breast Cancer Res Treat 129, 799–807 (2011). https://doi.org/10.1007/s10549-011-1668-y

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  • DOI: https://doi.org/10.1007/s10549-011-1668-y

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