Lege Artis Medicinae

[Letrozol therapy of postmenopausal women with early-stage breast carcinoma after four-six years of tamoxifen therapy: tolerability and quality of life]

TÓTH Éva Katalin1, NEMESKÉRI Csaba2, SZABÓ Barna3, URBANCSEK Hilda4, MÉSZÁROS Edina2, NAGYKÁLNAI Tamás5, PESTI Lajos6, MARKÓ László7, NAGY Beatrix8, LANDHERR László2

SEPTEMBER 22, 2013

Lege Artis Medicinae - 2013;23(09)

[INTRODUCTION - In patients with hormone- dependent breast cancer, five-year postoperative tamoxifen therapy is a standard treatment approach. Continuing this therapy for more than five years can increase the risk of recurrence of the disease. It has been shown that treatment with the third-generation aromatase inhibitor letrozol after discontinuation of tamoxifen therapy significantly improves disease-free survival. It is important to assess whether the substantial decrease of estrogen level shows a correlation with the occurrence of unwanted events/side effects or with changes in the quality of life. PATIENTS AND METHOD - Between 2005 and 2009, 921 women (mean age 63 years, age 40-94 years) with early-stage breast carcinoma were treated with expanded adjuvant letrozol therapy following tamoxifen treatment. Of these patients, 541 received previous tamoxifen therapy for 4-6 years. We studied relapses and quality of life - measured by the SF-36 survey - during letrozol therapy in the latter patient group and the occurrence of unwanted events and side effects in all 921 patients. The patients were examined eight times and completed the survey four times. RESULTS - At the check-ups, relapses were recorded in case of 20 patients. Quality of life scores significantly increased in two main categories - physical and mental health -, and within these in three subcategories, whereas decreasing scores were not recorded in any categories. In 921 patient taking letrozol, 73 experienced unwanted events/side effects, of which nine were severe and three patient died. The two most common side effects were joint and bone pain (18 patients) and heat rash (12 patients). CONCLUSION - Extended adjuvant therapy with letrozol efficiently decreased the number of relapses and the number of patients continuing therapy. On the basis of the SF-36 survey the patients’ quality of life generaly improved. Letrozol therapy was well tolerated by most patients, which can have a favourable effect on the outcome of the therapy.]

AFFILIATIONS

  1. Semmelweis Egyetem, III. Sz. Belgyógyászati Klinika
  2. Fôvárosi Önkormányzat Uzsoki Utcai Kórháza
  3. Borsod-Abaúj-Zemplén Megyei Kórház
  4. Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Sugárterápia Tanszék
  5. XV. Kerületi Önkormányzat Egészségügyi Intézménye
  6. Vas Megye és Szombathely MJV Markusovszky Kórháza Egyetemi Oktatókórház
  7. Bács-Kiskun Megyei Önkormányzat Kórháza
  8. Városi Kórház Keszthely

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[Individuals with an absent or dysfunctional spleen are at increased risk of severe infection. The greatest risk of infection is within two years after splenectomy. A spectrum of infecting microorganisms may cause serious infections, especially in young or immunocompromised patients. The commonest pathogens are Streptococcus pneumoniae, Neisseria meningitidis and in some countries Haemophilus influenzae type b (Hib). The international guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen are inconsistent. Most of the evidence is obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. This area in Hungary also represents an unmet need. Patients who have undergone surgical removal of the spleen and those with medical conditions that may predispose to functional hyposplenism must be educated about the danger of their condition, must be immunised and must be treated with prophylactic antibiotics according to national epidemiological and microbiological protocols. In Hungary we have an urgent need for a definite guideline for infection profilaxis of individuals with an absent or dysfunctional spleen. This paper is written by a vaccination consultant with the intention of raising awareness and to provide some assistence for physicians and their patients.]

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