Aromatase Inhibitors?

[osli]

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How did I manage to miss a whole class of drugs? Just ran across a metastatic breast cancer question in UW, and I've never even heard of that class of drugs. We covered tamoxifen/torimefine extensively in class, and they get an honorable mention in FA, but that one question just put 7 drugs on my list that are completely new to me.

What's up with that!? Is UW really just on pharm crack, or did our lecturer and FA miss a whole class of step-1 relevant drugs?

 

[TRKATK]

I haven't gotten to pharm yet, but this was pointed out in one line on our notes in path. 😱

 

[osli]

Now I have to go do a bunch of digging on the Clinical Pharmacology website and/or elsewhere.

Wouldn't these be very helpful in PCOS? If so why aren't they ever mentioned there, and if not why not? Jeez... I think I'm filling in holes only to learn that there are just more holes.

 

[DwyaneWade]

Now I have to go do a bunch of digging on the Clinical Pharmacology website and/or elsewhere.

Wouldn't these be very helpful in PCOS? If so why aren't they ever mentioned there, and if not why not? Jeez... I think I'm filling in holes only to learn that there are just more holes.

They have a bunch of SEs, they are important to recognize at the very least and they are pretty much used for breast cancer AFAIK.

 

[TerpMD]

Arguably, aromatase-I have fewer side effects than tamoxifen and are more effective (see pharmcards). They increase the risk of osteoporosis but don't increase endometrial ca and thomboembolic events like tamoxifen. They also cause arthalgias.

There was been research on these at my school so we heard about them often! 🙂

 

[DwyaneWade]

Arguably, aromatase-I have fewer side effects than tamoxifen and are more effective (see pharmcards). They increase the risk of osteoporosis but don't increase endometrial ca and thomboembolic events like tamoxifen. They also cause arthalgias.

There was been research on these at my school so we heard about them often! 🙂

Yes but raloxifene is much preferable.

 

[TerpMD]

Yes but raloxifene is much preferable.

I didn't know they had ever been directly compared. SERMs can be used for chemoprevention (AIs arent) but Raloxifene still has more risk of clot than AIs.

If we seriously need to know this for boards, I'm getting that question wrong bc I'm no oncologist. The important point in my opinion is that different SERMs have different ag/antag profiles in different tissues. AIs are their own class with their own set of +/-. Just my opinion.

 

[osli]

They have a bunch of SEs, they are important to recognize at the very least and they are pretty much used for breast cancer AFAIK.

👍
Figured it must be side effects limiting uses. Still hard to believe that I never heard about this entire class for two years and in multiple board review books, and it's not like it has an ultra-obscure mechanism or something... aromatization is right in the meat of the first two years!

 

[DwyaneWade]

I didn't know they had ever been directly compared. SERMs can be used for chemoprevention (AIs arent) but Raloxifene still has more risk of clot than AIs.

If we seriously need to know this for boards, I'm getting that question wrong bc I'm no oncologist. The important point in my opinion is that different SERMs have different ag/antag profiles in different tissues. AIs are their own class with their own set of +/-. Just my opinion.

Yeah I guess I am basing that off of more our department's preferences, but they are just starting some trials in the Northeast I believe comparing them...

Doubt it will be on step1

 

[g6pddfishnc]

.

 

[oreosandsake]

they're also used by muscle head's on steroids to prevent developing unsightly man boobies.

 

[TerpMD]

Yeah, I was kind of surprised that FA doesn't mention it at all. I read about the aromatase inhibitor anastrozole in the Katzung and Trevor pharm book, so I just added it to my notes in FA.
/quote]

Are you guys using FA07? Anastrozole is in FA 08 (P454) though it only gets one line.

 

[g6pddfishnc]

.

 

[MSKalltheway]

they're also used by muscle head's on steroids to prevent developing unsightly man boobies.

Why am I not surprised YOU said that!

 

[TerpMD]

Yep, using FA 2007. What does FA 2008 say about anastrozole?

Thanks!

Just one line "aromatase inhibitor used in postmenopausal women with breast cancer."

 

[racerx]

they're also used by muscle head's on steroids to prevent developing unsightly man boobies.

Lets keep the slang out of it. The correct medical terms are broasts or moobs. 😉

 

[osli]

they're also used by muscle head's on steroids to prevent developing unsightly man boobies.

Thanks! "Real world" uses always make things stick in my head better... now I'll never forget this one.

 

[radioh3ad]

postmenopausal ER+ breast cancer treatment.

especially after failure of tamoxifen treatment.

and yes, to prevent gynecomastia as an off label practice