Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors
Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors
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DOI：
10.1007/s10549-007-9774-6
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发表时间：
2008-09-01
影响因子：
3.8
通讯作者：
Clauw, Daniel J.
中科院分区：
文献类型：
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作者：
Henry, N. Lynn;Giles, Jon T.;Clauw, Daniel J.
目的芳香酶抑制剂(AIs)越来越多地被用于激素受体阳性乳腺癌的绝经后妇女的辅助治疗。人工授精通常与肌肉骨骼症状有关。这项研究的主要目标是描述在前100名受试者中出现的肌肉骨骼症状，这些受试者至少有6个月的随访。方法将激素受体阳性的早期乳腺癌患者纳入多中心随机临床试验，研究两种抗肿瘤药物依西美坦和来曲唑的药物基因组学。患者在基线、1个月、3个月、6个月和12个月分别完成健康评估问卷(HAQ)和视觉模拟评分(VAS)，以评估功能和疼痛的变化。如果患者的HAQ和/或VAS评分超过预定的阈值，则由风湿科医生转介进行评估。结果97例符合条件的患者中，44例(45.4%)符合风湿病转诊标准。3名患者因基线HAQ升高(2例)和未能启动人工智能治疗(1例)而不符合条件。没有基线特征与转诊显著相关。出现症状的中位时间为1.6个月(0.4-10个月)。对风湿病患者的临床和实验室评估表明，大多数患者要么出现非炎性肌肉骨骼症状，要么出现局限于腱鞘结构的炎症。13名患者在中位时间6.1个月(2.2-13个月)后因肌肉骨骼毒性而停止人工智能治疗。结论肌肉骨骼副作用在人工智能治疗的患者中很常见，导致超过10%的患者停止治疗。目前尚无可识别的治疗前风险指标，病因仍难以捉摸。
Purpose Aromatase inhibitors (AIs) are increasingly used as adjuvant treatment of postmenopausal women with hormone receptor-positive breast cancer. AIs are commonly associated with musculoskeletal symptoms. The primary objective of this study was to describe the musculoskeletal symptoms that developed in the first 100 subjects enrolled who had at least 6 months follow-up. Methods Women with early stage hormone receptor-positive breast cancer were recruited into a multicenter randomized clinical trial to study the pharmacogenomics of two AIs, exemestane, and letrozole. Patients completed the Health Assessment Questionnaire (HAQ) and Visual Analog Scale (VAS) at baseline, 1, 3, 6, and 12 months to assess changes in function and pain, respectively. Patients were referred for evaluation by a rheumatologist if their HAQ and/or VAS scores exceeded a predefined threshold. Results Forty-four of 97 eligible patients (45.4%) met criteria for rheumatologic referral. Three patients were ineligible because of elevated baseline HAQ (2) and failure to initiate AI therapy (1). No baseline characteristics were significantly associated with referral. Median time to onset of symptoms was 1.6 months (range 0.4-10 months). Clinical and laboratory evaluation of patients evaluated by rheumatology suggested that the majority developed either non-inflammatory musculoskeletal symptoms or inflammation localized to tenosynovial structures. Thirteen patients discontinued AI therapy because of musculoskeletal toxicity after a median 6.1 months (range 2.2-13 months). Conclusions Musculoskeletal side effects were common in AI-treated patients, resulting in therapy discontinuation in more than 10% of patients. There are no identifiable pre-therapy indicators of risk, and the etiology remains elusive.