Aromatase inhibitors: the journey from the state of the art to clinical open questions

Daniele Generali; Rossana Berardi; Michele Caruso; Marina Cazzaniga; Ornella Garrone; Ida Minchella; Ida Paris; Carmine Pinto; Sabino De Placido

doi:10.3389/fonc.2023.1249160

Aromatase inhibitors: the journey from the state of the art to clinical open questions

Front Oncol. 2023 Dec 22:13:1249160. doi: 10.3389/fonc.2023.1249160. eCollection 2023.

Authors

Daniele Generali^{1

2}, Rossana Berardi³, Michele Caruso⁴, Marina Cazzaniga^{5

6}, Ornella Garrone⁷, Ida Minchella⁸, Ida Paris⁹, Carmine Pinto¹⁰, Sabino De Placido¹¹

Affiliations

¹ Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy.
² Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
³ Medical Oncology, Azienda Ospedaliera Universitaria (AOU) delle Marche, University Politecnica delle Marche, Ancona, Italy.
⁴ Humanitas Istituto Clinico Catanese, Breast Centre Humanitas Catania, Catania, Italy.
⁵ School of Medicine and Surgery University of Milano Bicocca, Milan, Italy.
⁶ Phase 1 Research Unit, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, Italy.
⁷ Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁸ Division of Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy.
⁹ Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
¹⁰ Medical Oncology Unit, Comprehensive Cancer Centre, Azienda Unità Sanitaria Locale - Istituto di Ricerca e Cura a Carattere Scientifico (AUSL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy.
¹¹ Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Abstract

Breast cancer is a major cause of death among females. Great advances have been made in treating this disease, and aromatase inhibitors (AIs) have been recognized as the cornerstone. They are characterized by high efficacy and low toxicity. The authors reviewed the available literature and defined state-of-the-art AI management. This study was designed to assist clinicians in addressing the need to equally weigh patients' needs and disease control rates in their everyday clinical practice. Today, AIs play a central role in the treatment of hormone receptor-positive breast cancer. In this study, an expert panel reviewed the literature on the use of AIs, discussing the evolution of their use in various aspects of breast cancer, from pre- and postmenopausal early breast cancer to metastatic breast cancer, along with their management regarding efficacy and toxicity. Given the brilliant results that have been achieved in improving survival in everyday clinical practice, clinicians need to address their concerns about therapy duration and the adverse effects they exert on bone health, the cardiovascular system, and metabolism. Currently, in addition to cancer treatment, patient engagement is crucial for improving adherence to therapy and supporting patients' quality of life, especially in a selected subset of patients, such as those receiving an extended adjuvant or combination with targeted therapies. A description of modern technologies that contribute to this important goal is provided.

Keywords: aromatase inhibitors; bone loss; breast cancer; cardiotoxicity; drug adherence.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Editorial assistance was provided by Ethos through an unconditional grant by Accord. Accord had no role in the drafting and review of the manuscript.