Assessing the Effectiveness of Hormonal Aromatase inhibitors (AI) Therapy in Hormone Receptor Positive Post-Menopausal Breast Cancer Patients: A Systematic Review

Authors

  • Angki Perdiyana Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Agri Lesmana Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Dea Syafira Alamsyah Sitompul Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Fakhira Ayu Wijayanti Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Miko Dharma Alrasyid Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Naufal Yafi Rais Wiguna Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Tharisa Novianti Syabania Sutomo Medical Study Program, Faculty of Military Medicine, Indonesian Defense University
  • Deity Nugraha Medical Acupuncture Specialist Program, University of Indonesia
  • Elies Fitriani Medical Acupuncture Specialist Program, University of Indonesia

DOI:

https://doi.org/10.71341/bmwj.v1i2.7

Keywords:

aromatase inhibitors, breast cancer, postmenopausal, estrogen, progesterone

Abstract

Background: Endocrine therapy is a cornerstone in the treatment of breast cancer for patients who are hormone receptor-positive (HR+). Aromatase Inhibitors are a key option for managing HR+ breast cancer in postmenopausal women.

Objective: This study investigates the efficacy of Aromatase Inhibitors in postmenopausal women with HR+ breast cancer, focusing on their therapeutic benefits and associated risks.

Methods: A comprehensive literature review was conducted using the Cochrane, Google Scholar, PubMed, Science Direct, ClinicalTrials.gov, and Scopus databases, adhering to PRISMA guidelines. Study quality was evaluated using the Risk of Bias for Randomized Trials (RoB 2.0) tool.

Results: Aromatase Inhibitors function by inhibiting the aromatase enzyme, effectively reducing estrogen production. While they can be used with other therapies such as metformin or saracatinib, these combinations are not significantly more effective. Aromatase Inhibitors have been shown to enhance cognitive function and alleviate some depressive symptoms, although they may increase the risk of depression and anxiety in some patients.

Conclusion: Aromatase Inhibitors are an effective treatment for HR+ breast cancer in postmenopausal women. However, the potential psychological side effects, such as depression and anxiety, require careful management during therapy.

References

Aggelis, V., & Johnston, S. R. D. (2019). Advances in Endocrine-Based Therapies for Estrogen Receptor-Positive Metastatic Breast Cancer. Drugs, 79(17), 1849–1866. https://doi.org/10.1007/s40265-019-01208-8

Bahrami, N., Chang, G., Kanaya, N., Sauer, T., Park, D., Loeng, M., Gravdehaug, B., Chen, S., & Geisler, J. (2020). Changes in serum estrogenic activity during neoadjuvant therapy with letrozole and exemestane. The Journal of Steroid Biochemistry and Molecular Biology, 200, 105641. https://doi.org/10.1016/j.jsbmb.2020.105641

Boszkiewicz, K., Piwowar, A., & Petryszyn, P. (2022). Aromatase Inhibitors and Risk of Metabolic and Cardiovascular Adverse Effects in Breast Cancer Patients-A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 11(11). https://doi.org/10.3390/jcm11113133

Fitzal, F., Filipits, M., Fesl, C., Rudas, M., Greil, R., Balic, M., Moinfar, F., Herz, W., Dubsky, P., Bartsch, R., Ferree, S., Schaper, C., Gnant, M., & Austrian Breast and Colorectal Cancer Study Group (ABCSG). (2021). PAM-50 predicts local recurrence after breast cancer surgery in postmenopausal patients with ER+/HER2- disease: results from 1204 patients in the randomized ABCSG-8 trial. The British Journal of Surgery, 108(3), 308–314. https://doi.org/10.1093/bjs/znaa089

García-Sánchez, J., Mafla-España, M. A., Torregrosa, M. D., & Cauli, O. (2022). Adjuvant aromatase inhibitor treatment worsens depressive symptoms and sleep quality in postmenopausal women with localized breast cancer: A one-year follow-up study. Breast (Edinburgh, Scotland), 66, 310–316. https://doi.org/10.1016/j.breast.2022.11.007

Gnant, M., Fitzal, F., Rinnerthaler, G., Steger, G. G., Greil-Ressler, S., Balic, M., Heck, D., Jakesz, R., Thaler, J., Egle, D., Manfreda, D., Bjelic-Radisic, V., Wieder, U., Singer, C. F., Melbinger-Zeinitzer, E., Haslbauer, F., Sevelda, P., Trapl, H., Wette, V., … Greil, R. (2021). Duration of Adjuvant Aromatase-Inhibitor Therapy in Postmenopausal Breast Cancer. New England Journal of Medicine, 385(5), 395–405. https://doi.org/10.1056/NEJMoa2104162

Krásenská, M. (2016). [Treatment with Aromatase Inhibitors in Postmenopausal Women with Breast Cancer and the Possibility of Influencing Side Effects]. Klinicka Onkologie : Casopis Ceske a Slovenske Onkologicke Spolecnosti, 29 Suppl 3, S39-49. https://doi.org/10.14735/amko20163S39

Makkena, A., Appavu, R., & Kethar, J. (2023). Implications of Aromatase Inhibitor Therapy in Postmenopausal Breast Cancer. Journal of Student Research, 12(1). https://doi.org/10.47611/jsrhs.v12i1.4104

Martino, G., Catalano, A., Agostino, R. M., Bellone, F., Morabito, N., Lasco, C. G., Vicario, C. M., Schwarz, P., & Feldt-Rasmussen, U. (2020). Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PloS One, 15(3), e0230681. https://doi.org/10.1371/journal.pone.0230681

Mirsyad, A., Gani, A. B., Karim, M., Purnamasari, R., Karsa, N. S., Tanra, A. H., & Julia. (2022). Hubungan Usia Pasien Dengan Tingkat Stadium Kanker Payudara Di RS Ibnu Sina Makassar 2018. Jurnal Mahasiswa Kedokteran, 2(5), 359–367.

Ningrum, M. P., & Rahayu, R. S. R. (2021). Determinan Kejadian Kanker Payudara pada Wanita Usia Subur (15-49 Tahun). Indonesian Journal of Public Health and Nutrition, 1(3), 362–370.

Oswald, A. J., Symeonides, S. N., Wheatley, D., Chan, S., Brunt, A. M., McAdam, K., Schmid, P., Waters, S., Poole, C., Twelves, C., Perren, T., Bartlett, J., Piper, T., Chisholm, E. M., Welsh, M., Hill, R., Hopcroft, L. E. M., Barrett-Lee, P., & Cameron, D. A. (2023). Aromatase inhibition plus/minus Src inhibitor saracatinib (AZD0530) in advanced breast cancer therapy (ARISTACAT): a randomised phase II study. Breast Cancer Research and Treatment, 199(1), 35–46. https://doi.org/10.1007/s10549-023-06873-8

Peters, A., & Tadi, P. (2023). Aromatase Inhibitors. In StatPearls.

Zhao, Y., Gong, C., Wang, Z., Zhang, J., Wang, L., Zhang, S., Cao, J., Tao, Z., Li, T., Wang, B., & Hu, X. (2017). A randomized phase II study of aromatase inhibitors plus metformin in pre-treated postmenopausal patients with hormone receptor positive metastatic breast cancer. Oncotarget, 8(48), 84224–84236. https://doi.org/10.18632/oncotarget.20478

Downloads

Published

2024-11-27

How to Cite

Perdiyana , A., Lesmana , A., Sitompul , D. S. A., Wijayanti , F. A., Alrasyid , M. D., Wiguna , N. Y. R., … Fitriani, E. (2024). Assessing the Effectiveness of Hormonal Aromatase inhibitors (AI) Therapy in Hormone Receptor Positive Post-Menopausal Breast Cancer Patients: A Systematic Review. Bali Medical and Wellness Journal, 1(2). https://doi.org/10.71341/bmwj.v1i2.7