[MOL] Tamoxfen's protection extends with BRCA Mutations... [00019] Medicine On Line


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[MOL] Tamoxfen's protection extends with BRCA Mutations...



 

Tamoxifen’s Protection Extends to Women With BRCA Mutations
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TORONTO-Tamoxifen appears to protect breast-cancer patients with BRCA
mutations from contralateral disease.
  
In the first study to assess the effect of tamoxifen (Nolvadex,
AstraZeneca) on known carriers of BRCA1 and BRCA2 mutations, an
international team found that breast-cancer patients with the
mutations given tamoxifen were 50% less likely to develop disease in
the other breast than those who did not take the drug.
   
The case-control study found that 64 women with BRCA1 mutations
taking tamoxifen had a 62% risk reduction for developing
contralateral disease, Dr. Steven A. Narod of the University of
Toronto’s Sunnybrook and Women’s College Health Science Centre and
colleagues reported in the Dec. 2 Lancet. The 39 women with BRCA2
mutations taking the drug had a risk reduction of 32%.
  
However, this protective effect did not last longer than 10 years
after the drug was stopped. This point, Dr. Narod said, should be
noted by young women considering a prophylactic mastectomy.
   
The study compared 209 women with bilateral breast cancer and BRCA1
or BRCA2 mutations and 384 women with unilateral disease and BRCA1
or BRCA2 mutations. The women, accrued from genetics counseling
programs at 34 centers in eight countries, were interviewed an
average of 10 years after diagnosis. Thirteen percent of women with
BRCA1 mutations reported tamoxifen use, as did 33% of women with
BRCA2 mutations.
 
The greatest reduction in risk was among women who’d had an
oophorectomy in addition to taking tamoxifen. They were 80% less
likely to develop contralateral disease than women who had never
taken tamoxifen and had not had an oophorectomy. The effects of these
two treatments were independent but additive, the group reported,
and they persisted beyond 10 years. Chemotherapy was also an
independent source of risk reduction.
 
The protective effect of tamoxifen increased with use up to four
years, fading after that.
 
Dr. Narod said that the effect of tamoxifen on reduction of cancer-
associated mortality hadn’t been established, and it wasn’t clear
whether tamoxifen slows the growth of existing tumors or reduces the
development of new ones.
  
Nevertheless, he said, the group believes that tamoxifen will "reduce
the occurrence of primary cancers in BRCA1 and BRCA2 mutation
carriers, and that tamoxifen chemoprevention and other options
should be discussed with healthy women" who carry the mutations.
 
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