The University of Michigan (U-M) recently investigated the impact of aromatase inhibitor therapy on women with gynaecological cancers.
Sharon Ritchie (pictured) splits her time between Bloomfield, Michigan and Tucson, Arizona.
This lets the retired early childhood educator spend the colder months engaging in one of her favorite activities: golf.
Ritchie was diagnosed with stage IIIC low grade serous ovarian cancer in 2016 and treated by doctors at the University of Michigan Rogel Cancer Center. She found the biggest impact on her quality of life wasn’t the significant surgery or six rounds of chemotherapy, it was the side effects from the medicine that she started taking to stop her body from producing estrogen — an important player in many gynecologic cancers.
“I have some joint pain from arthritis and some neuropathy from the chemo, but the letrozole made things really bad,” she says. “My hands were quite swollen and there was a lot of pressure in my joints.”
Aromatase Inhibitors (AI) are hormone inhibitors that reduce the level of estrogen in the body. Examples include letrozole, anastrozole and exemestane. They are a common treatment for low-grade serous carcinoma (LGSC).
In breast cancer, studies have found 31% to 73% of women discontinue treatment within five years because of side effects. But little is known about AI- associated symptoms and discontinuation rates in gynecologic cancer patients
A recent study at the University of Michigan looked at the use, side effects and discontinuation of AIs in 146 women with gynaecological cancers. Similar to breast cancer, fifty six percent noted side effects – the most common of which were muscle and joint pain/stiffness, hot flashes and fatigue. Other side effects reported included osteopenia or osteoporosis, heel spurs, sciatic pain, lower extremity edema and upper extremity edema. But in contrast to breast cancer, disease progression was the most common reason for medication discontinuation. Just 5% of women discontinued treatment due to side effects.
“Even though patients with gynecologic cancer still have a lot of side effects, they don’t want to stop taking the medicine because they’re worried about their cancer,” McLean, study author, U-M. “For many of these patients, there aren’t many other treatment options available.”
“The kind of muscle and joint pain that aromatase inhibitors can cause can be quite debilitating,” Dr Andrews, U-M rehabilitation doctor, says. In Sharon’s case Dr Andews was able to find non-hormonal treatments to improve her symptoms. The drug duloxetine, an antidepressant and pain medication sold under the brand name Cymbalta, greatly alleviated Sharon’s joint pain so she could stay on AI treatment and play golf. “We want patients to know that this is something we can help manage, along with other symptoms they may be experiencing.”
Though study authors noted symptoms typically don’t respond well to conventional analgesics, “Gabapentin and SSRIs were found to be statistically significant in reducing rates of side effects among gynaecologic oncology patients on AI therapy.” Additionally muscular skeletal side effects were worse in exemestane compared to letrozole and anastrozole.
This study illustrates two points in particular. That women should feel able to discuss their side effects and symptoms with their doctors – because sometimes there are medications that can help. And the difficulties faced by women with LGSC who often have to endure side effects, that many women with breast cancer refuse to tolerate, because of a lack of effective treatments for their cancer.
Source: University of Michigan Dec 2nd 2020 (with permission)