A new generation of drugs including Aromasin and Arimidex are helping
to fight breast cancer in high-risk patients

The biologist Desmond Morris ridicules the widely accepted suggestion
that the male fascination with breasts is merely a relic of our
mammalian past. Morris emphasises that we are not like chimpanzees.
When female chimpanzees are not lactating, their breasts are flat.
Even when they are lactating, their male companions don't appear to be
much interested. Morris suggests that the difference between human and
mammal breasts is that ours are two thirds fat, and only a third
composed of tissue that is concerned with milk production. The fatty
portion has become a powerful sexual signal. The resulting emphasis on
breasts in advertising, art, fashion and seedy strip clubs has one
great advantage: few branches of medicine are the subject of so much
research.
Over 40,000 cases of breast cancer are diagnosed in this country every
year, and they account for 30 per cent of all female cancers. The
number of deaths attributed to breast cancer is around 12,000 a year,
whereas in 1989 there were 16,000. Eight out of ten cases of breast
cancer are diagnosed in post-menopausal women.

If breast screening, as advocated by the American Cancer Society, was
generally available, thousands of lives would be revolutionised. But
research is needed to find the treatment that will best provide
hormone-receptor-positive post-menopausal women with the best possible
chance of surviving their cancer.

At the American cancer conference in Atlanta this year, the latest
advance in the treatment of inflammatory breast cancer, lapatinib, was
announced. Last year, at the equivalent meeting, Herceptin, the drug
that has revolutionised breast cancer treatment for 20 to 25 per cent
of younger cases who are HER 2 positive, was introduced.

Recently there has been much interest in aromatase inhibitors, the
probable successors to the one-time wonder drug Tamoxifen for the
treatment of post-menopausal hormone-receptor-positive cancers.

The debate centres on how the aromatase inhibitors should be given
instead of Tamoxifen in those cases that are appropriate for it, and
whether they should be given immediately after surgery. Some
oncologists prefer women to be treated by a regime that switches to an
aromatase inhibitor after two or three years of Tamoxifen.

Switching from Tamoxifen to an aromatase inhibitor in this way will
still give women five years of hormonal adjuvant therapy (directed at
killing cancer cells that may have spread elsewhere in the body). This
form of treatment might have saved some women from experiencing
problems of osteoporosis and genital dryness, but conversely would
have made them more likely to have other uterine problems.

The recent research on the optimal pattern of aromatase inhibitor
treatment is of fundamental importance. Post-menopausal
hormone-receptor-positive early breast cancers usually receive some
of, or all of, the following treatments: surgery, radiotherapy,
chemotherapy and/or hormonal treatment.

One recent study involved Aromasin (exemestane), marketed by Pfizer.
It confirmed that switching to Aromasin after two or three years of
Tamoxifen treatment reduced dramatically the risk of the breast cancer
coming back, or of the breast cancer occurring in the previously
unaffected breast. Research indicated that overall survival was also
improved.

Another very extensive research project has studied three possible
treatment plans using Arimidex (anastrozole), manufactured by Astra
Zeneca. The first regime explored the advantages of giving Arimidex
for five years directly after surgery, rather than switching from
Tamoxifen later.

The second looked at changing all those patients who had been taking
Tamoxifen for two or three years to Arimidex, so as to complete five
years of adjuvant therapy. In the third programme, the women were
deliberately started on Tamoxifen with the intention of changing it to
Arimidex two or three years later.

The Arimidex trials showed that giving this aromatase inhibitor
directly after surgery for early breast cancer in
hormone-receptor-positive cancer in post-menopausal women gave the
best results and was superior to Tamoxifen and to switching from
Tamoxifen to an aromatase inhibitor after two or three years. The
side-effect profile, although affecting life in different ways, seemed
to balance.

It is generally accepted that high risk patients with cancers with the
necessary profile should have an aromatase inhibitor immediately after
surgery or switch to it if already on Tamoxifen.

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# posted by Network @ 6:43 AM