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Current Breast Cancer Reports
Published in: Current Breast Cancer Reports 3/2016

01-09-2016 | Invited Commentary

Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done?

Author: Polly Niravath

Published in: Current Breast Cancer Reports | Issue 3/2016

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Abstract

Aromatase inhibitor-induced arthralgia (AIA) remains a significant clinical dilemma for breast cancer survivors and their oncologists. Approximately half of women who take aromatase inhibitors (AIs) experience joint pain which often affects daily functioning and quality of life. Effects can be so severe that many women stop taking the AI; nonetheless, we know very little about what causes AIA, or how to effectively treat it. This article briefly describes the syndrome of AIA and then discusses several potential management strategies for this frequent clinical quandary.
Literature
1.
Howell A et al. Results of the ATAC (arimidex, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet. 2005;365(9453):60–2.CrossRefPubMed
2.
Group BIGC et al. Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N Engl J Med. 2009;361(8):766–76.CrossRef
3.
Coombes RC et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med. 2004;350(11):1081–92.CrossRefPubMed
4.
Goss PE et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst. 2005;97(17):1262–71.CrossRefPubMed
5.
6.
Henry NL et al. Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. Breast Cancer Res Treat. 2008;111(2):365–72.CrossRefPubMed
7.
Kadakia KC et al. Patient-reported outcomes and early discontinuation in aromatase inhibitor-treated postmenopausal women with early stage breast cancer. Oncologist. 2016;21(5):539–46.CrossRefPubMed
8.
Partridge AH et al. Adherence to initial adjuvant anastrozole therapy among women with early-stage breast cancer. J Clin Oncol. 2008;26(4):556–62.CrossRefPubMed
9.
Cuzick J et al. Treatment-emergent endocrine symptoms and the risk of breast cancer recurrence: a retrospective analysis of the ATAC trial. Lancet Oncol. 2008;9(12):1143–8.CrossRefPubMed
10.
Hadji P et al. Correlation of treatment-emergent adverse events and clinical response to endocrine therapy in early breast cancer: a retrospective analysis of the German cohort of TEAM. Ann Oncol. 2012;23(10):2566–72.CrossRefPubMed
11.
Huober J, C.B., Wu J, et. al. Symptoms of endocrine treatment and outcome: a retrospective analysis of the monotherapy arms of the BIG 1–98 trial. In American Society of Clinical Oncology. 2011. Chicago.
12.
Stearns V et al. Treatment-associated musculoskeletal and vasomotor symptoms and relapse-free survival in the NCIC CTG MA.27 adjuvant breast cancer aromatase inhibitor trial. J Clin Oncol. 2015;33(3):265–71.CrossRefPubMed
13.
Liedke PE et al. New onset vasomotor symptoms but not musculoskeletal symptoms associate with clinical outcomes on extended adjuvant letrozole—analyses from NCIC CTG MA.17. Breast. 2016;27:99–104.CrossRefPubMed
14.
Egawa C et al. Risk factors for joint symptoms in postmenopausal Japanese breast cancer patients treated with anastrozole: a prospective multicenter cohort study of patient-reported outcomes. Int J Clin Oncol. 2016;21(2):262–9.CrossRefPubMed
15.
Sestak I et al. Risk factors for joint symptoms in patients enrolled in the ATAC trial: a retrospective, exploratory analysis. Lancet Oncol. 2008;9(9):866–72.CrossRefPubMed
16.
Mieog JS et al. Carpal tunnel syndrome and musculoskeletal symptoms in postmenopausal women with early breast cancer treated with exemestane or tamoxifen after 2–3 years of tamoxifen: a retrospective analysis of the Intergroup Exemestane Study. Lancet Oncol. 2012;13(4):420–32.CrossRefPubMed
17.
Crew KD et al. Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol. 2007;25(25):3877–83.CrossRefPubMed
18.
Servitja S et al. Skeletal adverse effects with aromatase inhibitors in early breast cancer: evidence to date and clinical guidance. Ther Adv Med Oncol. 2015;7(5):291–6.CrossRefPubMedPubMedCentral
19.
Irwin ML et al. Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. J Clin Oncol. 2015;33(10):1104–11.CrossRefPubMed
20.
Lahart IM et al. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015;54(5):635–54.CrossRefPubMed
21.
Peppone LJ et al. The effect of YOCAS(c)(R) yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Breast Cancer Res Treat. 2015;150(3):597–604.CrossRefPubMedPubMedCentral
22.
Galantino ML et al. Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther. 2012;11(4):313–20.CrossRefPubMed
23.
Jacobsen PB et al. Pilot study of Iyengar yoga for management of aromatase inhibitor-associated arthralgia in women with breast cancer. Psychooncology. 2015;24(11):1578–80.CrossRefPubMedPubMedCentral
24.
Khan N et al. Repeated assessment of orthotopic glioma pO(2) by multi-site EPR oximetry: a technique with the potential to guide therapeutic optimization by repeated measurements of oxygen. J Neurosci Methods. 2012;204(1):111–7.CrossRefPubMed
25.
Rastelli AL et al. Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial. Breast Cancer Res Treat. 2011;129(1):107–16.CrossRefPubMed
26.
Khan, Q.K., Bruce F., Reddy, PS; Sharma, P; Klemp, JR; Fabia, CJ, Randomized trial of vitamin D3 to prevent worsening of musculoskeletal symptoms and fatigue in women with breast cancer starting adjuvant letrozole: the VITAL trial, in ASCO Annual Meeting. 2012: Chicago.
27.
Prieto-Alhambra D et al. Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat. 2011;125(3):869–78.CrossRefPubMed
28.
Shapiro AC et al. Randomized, blinded trial of vitamin D3 for treating aromatase inhibitor-associated musculoskeletal symptoms (AIMSS). Breast Cancer Res Treat. 2016;155(3):501–12.CrossRefPubMed
29.
Crew KD et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol. 2010;28(7):1154–60.CrossRefPubMed
30.
Mao JJ et al. A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer. 2014;50(2):267–76.CrossRefPubMed
31.
Oh B et al. Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: pilot study. Acupunct Med. 2013;31(3):264–71.CrossRefPubMed
32.
Bao T et al. A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Res Treat. 2013;138(1):167–74.CrossRefPubMedPubMedCentral
33.
Bae K et al. Acupuncture for aromatase inhibitor-induced arthralgia: a systematic review. Integr Cancer Ther. 2015;14(6):496–502.CrossRefPubMed
34.
Xepapadakis G et al. New views on treatment of aromatase inhibitors induced arthralgia. Breast. 2010;19(3):249–50.CrossRefPubMed
35.
Muslimani AA et al. Aromatase inhibitor-related musculoskeletal symptoms: is preventing osteoporosis the key to eliminating these symptoms? Clin Breast Cancer. 2009;9(1):34–8.CrossRefPubMed
36.
Kubo M et al. Short-term and low-dose prednisolone administration reduces aromatase inhibitor-induced arthralgia in patients with breast cancer. Anticancer Res. 2012;32(6):2331–6.PubMed
37.
Henry NL et al. Pilot study of duloxetine for treatment of aromatase inhibitor-associated musculoskeletal symptoms. Cancer. 2011;117(24):5469–75.CrossRefPubMed
38.
Hershman DL et al. Randomized multicenter placebo-controlled trial of omega-3 fatty acids for the control of aromatase inhibitor-induced musculoskeletal pain: SWOG S0927. J Clin Oncol. 2015;33(17):1910–7.CrossRefPubMedPubMedCentral
39.
Briot K et al. Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study. Breast Cancer Res Treat. 2010;120(1):127–34.CrossRefPubMed
40.
Burstein HJ et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014;32(21):2255–69.CrossRefPubMedPubMedCentral
Metadata
Title
Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done?
Author
Polly Niravath
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Breast Cancer Reports / Issue 3/2016
Print ISSN: 1943-4588
Electronic ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-016-0217-4

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