William J. Gradishar, MD reviewing Meggetto O et al. J Clin Oncol 2017 Jan 9.
False attribution of symptoms to chemoprevention agents should be considered.
Chemoprevention strategies for reducing the risk for developing breast cancer have been available for more than 20 years, yet only a small fraction of eligible women choose to participate, and of those that do, a significant fraction do not complete the recommended course of an aromatase inhibitor, tamoxifen, or raloxifene. An analysis of causes of discontinuation of treatment at 12 months in the MAP.3 study was recently published (NEJM JW Oncol Hematol Jun 2014 and J Clin Oncol 2014; 32:1427). Women were deemed high risk and eligible to participate in MAP.3 if they were postmenopausal and had at least one the following breast cancer risk factors: age ≥60 years, Gail score >1.66%, or a prior diagnosis of benign breast disease.
Investigators have now examined reasons for discontinuation of treatment among 4501 women in the MAP.3 trial who received either exemestane or placebo daily for 5 years. Participants were assessed using the Menopause-Specific Quality of Life Questionnaire (MENQOL) at the outset and at 6 months. Baseline clinical and personal characteristics were also obtained.
Among all participants, 17% discontinued treatment within 12 months; 19% discontinued exemestane, and 13% discontinued placebo. Between 19% and 35% of women reported a worsening of vasomotor, sexual, physical, and psychosocial MENQOL domains; worsening in any domain was associated with an increased risk for discontinuation. Women who smoked were also more likely to quit treatment, which may have been due to the known effect of smoking on vasomotor symptoms. Also, women who were employed were more likely to discontinue treatment, which may be an indicator that any symptoms that interfere with work life would not be acceptable.
CITATION(S):
Meggetto O et al. Factors associated with early discontinuation of study treatment in the Mammary Prevention.3 breast cancer chemoprevention trial. J Clin Oncol 2017 Jan 9; [e-pub].
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