Summary
Thirty-four post-menopausal women with early breast cancer who had received 20 mg tamoxifen once daily as adjuvant therapy for at least 10 weeks participated in a randomized, double-blind, parallel-group, multicentre trial. The primary aim of the trial was to determine the effect of anastrozole upon tamoxifen pharmacokinetics, with secondary aims of assessing the tolerability of the two drugs in combination and whether or not tamoxifen had any effect upon the oestradiol suppression seen with anastrozole. Patients were randomized to receive either 1 mg anastrozole (16 patients) or matching placebo (18 patients) once daily on a double-blind basis for 28 days. No significant difference (P = 0.919) was observed in serum tamoxifen concentrations between the anastrozole and placebo groups during the trial. The serum concentration of oestradiol was significantly suppressed (P < 0.0001) in patients co-administered anastrozole compared with placebo in the presence of tamoxifen, confirming that anastrozole remained an effective suppressant of oestradiol in the presence of tamoxifen. The combination of tamoxifen and anastrozole was well tolerated, with very little difference in side-effects reported between anastrozole and placebo. In conclusion, the results of this study confirm that anastrozole does not affect the pharmacokinetics of tamoxifen when the two drugs are given in combination to post-menopausal women with early breast cancer. In addition, the oestradiol suppressant effects of anastrozole appear unaffected by tamoxifen.
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References
Bratherton, D. G., Brown, C. H., Buchanan, R., Hall, V., Kingsley Pillers, E. M., Wheeler, T. K. & Williams, C. J. (1984). A comparison of two doses of tamoxifen (Nolvadex) in postmenopausal women with advanced breast cancer: 10 mg bd versus 20 mg bd. Br J Cancer 50: 199–205.
Buzdar, A., Jonat, W., Howell, A., Jones, S. E., Blomqvist, C., Vogel, C. L., Eirmann, W., Wolter, J. M., Azab, M., Webster, A. & Plourde, P. V. (1996). Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal women with advanced breast cancer: result of overview analysis of two phase III trials. J Clin Oncol 14: 2000–2011.
Buzdar, A., Jonat, W., Howell, A., Yin, H. & Lee, D., The Arimidex International Study Group (1997). Significant improved survival with Arimidex (anastrozole) versus megestrol acetate in postmenopausal advanced breast cancer: updated results of two randomized trials (abstract 545). Proc Am Soc Clin Oncol 16: 156a
Dowsett, M., Goss, P. E., Powles, T. J., Hutchinson, G., Brodie, A. M. H., Jeffcoate, S. L. & Coombes, R. C. (1987). Use of the aromatase inhibitor 4-hydroxyandrostenedione in postmenopausal breast cancer: optimization of therapeutic dose and route. Cancer Res 47: 1957–1961.
Dowsett, M., Yates, R. & Wong, W. J. (1998). ‘Arimidex’ (anastrozole): lack of interactions with tamoxifen, antipyrine, cimetidine and warfarin. Eur J Cancer, 34(suppl. 1): S39–S40.
Dukes, M., Edwards, P. N., Large, M., Smith, I. K. & Boyle, T. (1996). The preclinical pharmacology of ‘Arimidex’ (Anastrozole; ZD1033) – a potent selective aromatase inhibitor. J Steroid Biochem Mol Biol 58: 439–445.
Frenay, M., Peyrade, F., Étienne, M. C., Ruch, F., Milano, G., François, E., Ferrero, J. M., Ibrahim-Gobert, C. & Namer, M. (1994). Population pharmacokinetics of tamoxifen and its metabolites: a study of 316 patients with breast cancer (abstract). Bulletin du Cancer 81: 489–490.
Geisler, J., King, N., Dowsett, M., Ottestad, L., Lundgren, S., Walton, P., Kormeset, P. O. & Lønning, P. E. (1996). Influence of anastrozole (Arimidex), a selective, non-steroidal aromatase inhibitor, on in vivo aromatization and plasma oestrogen levels in post-menopausal women with breast cancer. Br J Cancer 74: 1286–1291.
Gelber, R., Goldhirsch, A. & Coates, A. S. (1993). Adjuvant therapy for breast cancer. Understanding the overview. J Clin Oncol 11: 580–585.
Howell, A. & Dowsett, M. (1997). Recent advances in endocrine therapy of breast cancer. Br Med J 315: 863–866.
Howell, A., Downey, S. & Anderson, E. (1996). New endocrine therapies for breast cancer. Eur J Cancer 32A: 576–588.
Ingle, J. N., Green, S. J., Ahmann, D., Long, H. J., Edmonson, J. H., Rubin, J., Chang, M. N. & Creagan, E. T. (1986). Randomized trial of tamoxifen alone or combined with aminoglutethimide and hydrocortisone in women with metastatic breast cancer. J Clin Oncol 4: 958–964.
Jacolot, F., Simon, I., Dreano, Y., Beaune, P., Riche, C. & Berthou, F. (1991). Identification of the cytochrome P450 IIIA family as the enzymes involved in the N-demethylation of tamoxifen in human liver microsomes. Biochem Pharmacol 41: 1911–1919.
Johnston, S. R. D., Haynes, B. P., Sacks, N. P. M., McKinna, J. A., Griggs, L. J., Jarman, M., Baum, M., Smith, I. E. & Dowsett, M. (1993). Effect of oestrogen receptor status and time on the intratumoural accumulation of tamoxifen and N-desmethyltamoxifen following short-term therapy in human breast cancer. Breast Cancer Res Treat 28: 241–250.
Lien, E. A., Anker, G., Lønning, P. E., Solheim, E. & Ueland, P. M. (1990). Decreased serum concentrations of tamoxifen and its metabolites induced by aminoglutethimide. Cancer Res 50: 5851–5857.
Milstead, R., Habeshaw, T., Kaye, S., Sangster, G., Macbeth, F., Campbell-Ferguson, J., Smith, D. & Calman, K. (1985). A randomized trial of tamoxifen versus tamoxifen and aminoglutethimide in postmenopausal women with advanced breast cancer. Cancer Chemother Pharmacol 14: 272–273.
Patterson, J. S., Settatree, R. S., Adam, H. K. & Kemp, J. V. (1980). Serum concentrations of tamoxifen and major metabolite during long term Nolvadex therapy, correlated with clinical response. Eur J Cancer, (suppl. 1)89–92.
Plourde, P. V., Dyroff, M. & Dukes, M. (1994). Arimidex: a potent and selective fourth-generation aromatase inhibitor. Breast Cancer Res Treat 30: 103–111.
Rose, C., Kamby, C., Mourisden, H. T., Bastholt, L., Brincker, H., Skovgaard-Poulsen, H., Andersen, A. P., Loft, H., Dombernowsky, P. & Andersen, K. W. (1986). Combined endocrine treatment of postmenopausal patients with advanced breast cancer. A randomized trial of tamoxifen vs. tamoxifen plus aminoglutethimide and hydrocortisone. Breast Cancer Res Treat 7: S45–50.
Smith, I. E., Macaulay, V. & Bozek, T. (1986). Comparative studies of ‘Nolvadex’ and aminoglutethimide alone and in combination in advanced breast cancer. Rev Endocr Related Cancer, (suppl. 18)21–25.
Yates, R. A., Dowsett, M., Fisher, G. V., Selen, A. & Wyld, P. J. (1996). Arimidex (ZD1033): a selective, potent inhibitor of aromatase in postmenopausal female volunteers. Br J Cancer 73: 543–548.
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Dowsett, M., Tobias, J., Howell, A. et al. The effect of anastrozole on the pharmacokinetics of tamoxifen in post-menopausal women with early breast cancer. Br J Cancer 79, 311–315 (1999). https://doi.org/10.1038/sj.bjc.6690050
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DOI: https://doi.org/10.1038/sj.bjc.6690050
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