Exxcellence pearls: breast cancer on Letrozole Flashcards
What are the three most common cancers among women?
What are the three leading causes of cancer death among women?
Breast, lung, colorectal cancer
Lung, breast, colorectal cancer
What percentage of breast cancers are estrogen or progesterone receptor positive?
What class of medicines are most effective at preventing recurrence?
75%
Aromatase inhibitors
What is the normal amount of estrone produced by postmenopausal women?
100 µg per day. More with obesity.
What is the mechanism of action for aromatase inhibitors?
Prevents conversion of androstenedione to estrone in the adipose tissue
What percentage of people discontinue letrozole due to side effects?
What are the side effects?
10–20%
Exacerbation of post menopausal symptoms, decreased bone mineral density.
If letrozole reactivates ovarian function and promotes menses, what should be done?
Discontinue medication.
What is the risk of endometrial neoplasia with aromatase inhibitors?
No increased risk.
What testing needs to be done before starting and aromatase inhibitor?
Bone mineral density measurement. Possibly vitamin D levels.
What are common sites of arthralgia associated with aromatase inhibitors?
Knees, hands and wrists and shoulders
How often should bone mineral density be followed in women on aromatase inhibitors?
Yearly
What is the risk of thrombosis with aromatase inhibitors?
No increased risk. Some older studies suggested a risk of VTE and cardiovascular health concerns.
What is denosumab?
An alternative treatment for bone loss if bisphosphonates fail. It is a humanized monoclonal antibody to inhibit RANKL, a tumor necrosis factor ligand essential for osteoclast function.
