Post-menopausal

Yes, as you mentioned Dr. Paul Goss presented the findings on exemestane for breast cancer prevention at ASCO and his group published their findings in the New England of Medicine in June 2011. Like many new findings it may take a while to catch on especially for chemoprevention, as the other options (tamoxifen, raloxifene) have not been popular with either the breast specialists or the patients due to the side effects (menopausal symptoms, blood clots, uterine bleeding, endometrial cancer, cataracts, etc). Asking healthy patients to take medications with minimal or serious side effects can be a hard sell. Yes, as you mentioned Dr. Paul Goss presented the findings on exemestane for breast cancer prevention at ASCO and his group published their findings in the New England of Medicine in June 2011. Like many new findings it may take a while to catch on especially for chemoprevention, as the other options (tamoxifen, raloxifene) have not been popular with either the breast specialists or the patients due to the side effects (menopausal symptoms, blood clots, uterine bleeding, endometrial cancer, cataracts, etc). Asking healthy patients to take medications with minimal or serious side effects can be a hard sell.

Both you and your physician will be monitoring the potential risks of letrozole.

The risks that may cause the most concern are:
- Decreases in bone mineral density (BMD).
- Increases in cholesterol.

The patient should be aware and notify the physician of any changes in how they feel, particularly paying attention to bone pain and liver pain (upper right quadrant).

The way to monitor these risks are through the following:
- bone density test
- complete blood cell counts (CBC)
- thyroid function tests
- monitoring serum electrolytes
- monitoring cholesterol and liver function tests, kidney function, and blood pressure.

There will also be the physical assessment of the patient. This will include blood pressure readings, pain assessment, gastrointestinal upsets, and hot flashes.

When initiating letrozole treatment, patients may experience dizziness and fatigue. Until your body adjusts be cautious before performing work that requires mental alertness, such as driving.

For more information, see the follwing links:

http://www.rxlist.com/femara-drug.htm
http://www.webmd.com/drugs/drug-4363-Femara+Oral.aspx?drugid=4363&drugname=Femara+Oral Both you and your physician will be monitoring the potential risks of letrozole.

The risks that may cause the most concern are:
- Decreases in bone mineral density (BMD).
- Increases in cholesterol.

The patient should be aware and notify the physician of any changes in how they feel, particularly paying attention to bone pain and liver pain (upper right quadrant).

The way to monitor these risks are through the following:
- bone density test
- complete blood cell counts (CBC)
- thyroid function tests
- monitoring serum electrolytes
- monitoring cholesterol and liver function tests, kidney function, and blood pressure.

There will also be the physical assessment of the patient. This will include blood pressure readings, pain assessment, gastrointestinal upsets, and hot flashes.

When initiating letrozole treatment, patients may experience dizziness and fatigue. Until your body adjusts be cautious before performing work that requires mental alertness, such as driving.

For more information, see the follwing links:

http://www.rxlist.com/femara-drug.htm
http://www.webmd.com/drugs/drug-4363-Femara+Oral.aspx?drugid=4363&drugname=Femara+Oral

Anastrozole is indicated for:
- Treatment of hormone receptor-positive early and metastatic breast cancer in post-menopausal women. It may be used alone or after surgery or radiation. (Early breast cancer is cancer that has not spread outside the breast to other parts of the body.)
- Treatment of hormone receptor-positive breast cancer that has progressed after receiving tamoxifen treatment for post-menopausal women.
- Post-menopausal women where the ER-positive or hormone receptor unknown breast cancer has spread in the breast or to other parts of the body.

For more information, see the following link:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/ Anastrozole is indicated for:
- Treatment of hormone receptor-positive early and metastatic breast cancer in post-menopausal women. It may be used alone or after surgery or radiation. (Early breast cancer is cancer that has not spread outside the breast to other parts of the body.)
- Treatment of hormone receptor-positive breast cancer that has progressed after receiving tamoxifen treatment for post-menopausal women.
- Post-menopausal women where the ER-positive or hormone receptor unknown breast cancer has spread in the breast or to other parts of the body.

For more information, see the following link:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/

There is no dosage adjustment for patients taking anastrozole with normal liver function. The physician will monitor the patient's liver function and change medications if needed.
- For elderly post-menopausal women, there are no recommendations to change the dose.
- For patients with mild to moderate liver disease, as determined by liver function tests, there are no recommendations to change the dose.
- In patients with severe liver disease there have been no studies to conclude if the dose should be changed. The physician will decide whether to change medications.

For more information, see the following links:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/
http://www.drugs.com/pro/arimidex.html
http://www.rxlist.com/arimidex-drug.htm There is no dosage adjustment for patients taking anastrozole with normal liver function. The physician will monitor the patient's liver function and change medications if needed.
- For elderly post-menopausal women, there are no recommendations to change the dose.
- For patients with mild to moderate liver disease, as determined by liver function tests, there are no recommendations to change the dose.
- In patients with severe liver disease there have been no studies to conclude if the dose should be changed. The physician will decide whether to change medications.

For more information, see the following links:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/
http://www.drugs.com/pro/arimidex.html
http://www.rxlist.com/arimidex-drug.htm

There is no dosage adjustment of letrozole for patients with normal kidney and liver function. The physician will monitor for kidney and liver function using kidney and liver function tests and change medications if needed.

- With mild to moderate impairment of the liver, the dose of letrozole will not be changed.
- For post menopausal women taking Letrozole with liver problems (cirrhosis and severe hepatic impairment), as determined by liver function tests, the dose recommended for this patient population is 2.5mg every other day.
- There is no change in dosage requirements for patients with a creatinine clearance of the kidneys greater than or equal to 10ml/min.

For more information on this subject, see the following links:
http://www.rxlist.com/femara-drug.htm
http://www.drugs.com/dosage/letrozole.html There is no dosage adjustment of letrozole for patients with normal kidney and liver function. The physician will monitor for kidney and liver function using kidney and liver function tests and change medications if needed.

- With mild to moderate impairment of the liver, the dose of letrozole will not be changed.
- For post menopausal women taking Letrozole with liver problems (cirrhosis and severe hepatic impairment), as determined by liver function tests, the dose recommended for this patient population is 2.5mg every other day.
- There is no change in dosage requirements for patients with a creatinine clearance of the kidneys greater than or equal to 10ml/min.

For more information on this subject, see the following links:
http://www.rxlist.com/femara-drug.htm
http://www.drugs.com/dosage/letrozole.html

Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole

Anastrozole treats breast cancer by inhibiting the production of estrogen in tissues of the body of post-menopausal women.
- By inhibiting the production of estrogen, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive cancer cells cannot grow.
- Anastrozole operates by blocking the aromatase enzyme that converts androgen to estrogen in the tissues of women who have gone through menopause.
- Postmenopausal women get estrogen from the conversion of androgen into estrogen in the tissues of the body.
- In women who have not gone through menopause, they receive their estrogen from the ovaries.
- Anastrozole is categorized pharmacologically as an antineoplastic agent and as a nonsteroidal aromatase inhibitor and is indicated for postmenopausal women. Anastrozole treats breast cancer by inhibiting the production of estrogen in tissues of the body of post-menopausal women.
- By inhibiting the production of estrogen, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive cancer cells cannot grow.
- Anastrozole operates by blocking the aromatase enzyme that converts androgen to estrogen in the tissues of women who have gone through menopause.
- Postmenopausal women get estrogen from the conversion of androgen into estrogen in the tissues of the body.
- In women who have not gone through menopause, they receive their estrogen from the ovaries.
- Anastrozole is categorized pharmacologically as an antineoplastic agent and as a nonsteroidal aromatase inhibitor and is indicated for postmenopausal women.

Letrozole (Femara) is an antineoplastic agent. Antineoplastic agents are anticancer medications. Letrozole is also categorized as a nonsteroidal aromatase inhibitor. Aromatase inhibitors do not allow the aromatase enzyme to convert androgen into estrogen in the tissues. By blocking estrogen production in the tissues of the body, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive) breast cancer cells cannot grow. Letrozole (Femara) is an antineoplastic agent. Antineoplastic agents are anticancer medications. Letrozole is also categorized as a nonsteroidal aromatase inhibitor. Aromatase inhibitors do not allow the aromatase enzyme to convert androgen into estrogen in the tissues. By blocking estrogen production in the tissues of the body, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive) breast cancer cells cannot grow.

First of all, your physician should test to make sure that you are post-menopausal.

Aromatase inhibitors are the most common hormonal treatment for post-menopausal women. The three most prescribed are:
- Arimidex (chemical name: anastrozole)
- Femara (chemical name: letrozole)
- Aromasin (chemical name: exemestane)

Alternative treatments are:
- tamoxifen
- Faslodex (fulvestrant)
- Fareston (toremifene)
- Megace (megestrol)
- Halotestin (fluoxymesterone)

A combination of the above therapies might be considered in some cases.

If the side effects are too severe, you might consider changing treatments.

Sometimes though, the cancer changes and the hormonal treatment is ineffective or might even fuel the cancer. In these cases, the treatments should stop and potentially another hormonal therapy can be tried. First of all, your physician should test to make sure that you are post-menopausal.

Aromatase inhibitors are the most common hormonal treatment for post-menopausal women. The three most prescribed are:
- Arimidex (chemical name: anastrozole)
- Femara (chemical name: letrozole)
- Aromasin (chemical name: exemestane)

Alternative treatments are:
- tamoxifen
- Faslodex (fulvestrant)
- Fareston (toremifene)
- Megace (megestrol)
- Halotestin (fluoxymesterone)

A combination of the above therapies might be considered in some cases.

If the side effects are too severe, you might consider changing treatments.

Sometimes though, the cancer changes and the hormonal treatment is ineffective or might even fuel the cancer. In these cases, the treatments should stop and potentially another hormonal therapy can be tried.