Raloxifene may be more acceptable choice for breast cancer prevention than tamoxifen
Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer in at-risk postmenopausal women and may be a more acceptable choice for chemoprevention, according to US researchers.
Victor Vogel, of the Magee-Womens Hospital, University of Pittsburgh
school of medicine, and colleagues conducted a randomised controlled
trial to compare the two agents (tamoxifen 20mg daily and raloxifene
60mg daily over five years) in almost 20,000 women with a mean five-year
breast cancer risk of 4.03 per cent.
The researchers observed 163 cases of invasive breast cancer (the primary
outcome of the study) in women assigned to tamoxifen compared with 168
cases in women assigned to raloxifene — a non-significant difference — which
translates to an incidence of 4.30 and 4.41 cases per 1,000, respectively.
Secondary outcome analyses revealed different side effect profiles for
the two drugs. For example, raloxifene was associated with fewer cases
of uterine cancer but more cases of non-invasive breast cancer than tamoxifen.
Neither difference was statistically significant, however. Thromboembolic
events occurred less often in the raloxifene group and there were fewer
cataracts in that group. No significant differences were found for other
invasive cancers, for ischaemic heart disease events or for stroke. The
number of osteoporotic fractures in the two groups was also similar and
there were no differences in the total number of deaths or in causes
of death. The researchers suggest that raloxifene might be seen as a
more acceptable choice for chemoprevention because of its established
use in osteoporosis prevention.
In a second study, researchers analysed quality of life data from the
same group of women and found no significant differences for physical
and mental health.
Data from the trial, known as STAR (study of tamoxifen and raloxifene),
were presented earlier this week at the American
Society of Clinical Oncology annual meeting, held in Atlanta, Georgia.
The studies were also published online by JAMA to coincide with the meeting.
JAMA abstracts
Effects
of Tamoxifen vs Raloxifene on the Risk of Developing Invasive Breast
Cancer and Other Disease Outcomes
Patient-Reported
Symptoms and Quality of Life During Treatment With Tamoxifen or Raloxifene
for Breast Cancer Prevention
Selective
Estrogen Receptor Modulators and Prevention of Invasive Breast Cancer
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