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Low-Dose Tamoxifen Halves Breast Cancer Risk in Women

    • 1384 posts
    August 8, 2019 11:14 AM EDT
    5 mg/d, given for 3 years rather than 5 years—halved the risk of
    breast cancer recurrence or new lesions over placebo in women with
    breast intraepithelial neoplasia, without producing the usual toxicities
    seen with the standard dose, Italian researchers reported at the 2018
    San Antonio Breast Cancer Symposium.1
    “We believe our results have
    external validity and—given their pragmatic nature and the easy
    accessibility of tamoxifen—are generalizable,” said Andrea De Censi, MD,
    of the National Hospital E.O. Ospedali Galliera–Division of Medical
    Oncology in Genoa, Italy. “Tamoxifen, 5 mg a day (splitting the tablet)
    or 10 mg every other day, is applicable in clinical practice tomorrow.”Nolvadex dosage

    Breast cancer experts at the meeting said this is news they can use.
    “Looking at these data, I would definitely give lower doses of
    tamoxifen, especially in patients with atypical ductal hyperplasia and
    lobular carcinoma in situ,” said Virginia G. Kaklamani, MD, Professor of
    Medicine at The University of Texas at San Antonio and leader of the
    Breast Cancer Program at The University of Texas MD Anderson Cancer
    Center, Houston.
    This information tells me I can perhaps cut back on
    the dose for patients who are not tolerating tamoxifen. This would help
    me keep them on the dose, rather than have them abandon therapy,” said
    John Cole, MD, of the Ochsner Health System in New Orleans.

    ALTHOUGH TAMOXIFEN is effective in preventing breast cancer
    recurrence, its side effects—menopausal symptoms, endometrial cancer,
    deep-vein thrombosis, and pulmonary embolism— are barriers for its use
    as a preventive measure. The aim of this de-escalation study was to
    determine whether a lower dose and shorter duration of tamoxifen therapy
    would be as efficacious as and better tolerated than the standard dose.

    Dr. De Censi and colleagues had previously shown that a dose as low
    as 1 mg/d is noninferior to 20 mg in decreasing Ki67 (a marker of
    proliferation), though less effective in modulating serum biomarkers.2
    For the current study, the investigators decided 5 mg/d would be a
    reasonable compromise between activity and safety. He explained that the
    government- and charity-funded study could not afford to financially
    support the use of a very large noninferiority trial of tamoxifen at 20
    mg/d for 5 years as the control arm.