BACKGROUND:
Tamoxifen has emerged as a potential management
option for gynecomastia and breast pain due to non-steroidal antiandrogens, and
it is considered an alternative to surgery or radiotherapy. The objective of
this systematic review was to assess the benefits and harms of tamoxifen, in
comparison to other treatment options, for either the prophylaxis or treatment
of breast events induced by non-steroidal antiandrogens in prostate cancer
patients.
METHODS:
We searched CENTRAL, MEDLINE, EMBASE, reference
lists, the abstracts of three major conferences and three trial registers to
identify ongoing randomized controlled trials (RCTs). Two authors independently
screened the articles identified, assessed the trial quality and extracted
data. The protocol was prospectively registered (CRD42011001320;
http://www.crd.york.ac.uk/PROSPERO).
RESULTS:
Four studies were identified. Tamoxifen
significantly reduced the risk of suffering from gynecomastia (RR 0.10, 95% CI
0.05-0.22) or breast pain (RR 0.06, 95% CI 0.02-0.17) at 6 months compared to
untreated controls. Tamoxifen also showed a significant benefit for the prevention
of gynecomastia (RR 0.22, 95%CI 0.08-0.58) and breast pain (RR 0.25, 95% CI
0.10-0.64) when compared to anastrozole after a median of 12 months. One study
showed a significant benefit of tamoxifen for the prevention of gynecomastia
(RR 0.24, 95%CI 0.09-0.65) and breast pain (RR 0.20, 95% CI 0.06-0.65) when
compared with radiotherapy at 6 months. Radiotherapy increased the risk of
suffering from nipple erythema and skin irritation, but there were no
significant differences for any other adverse events (all p>0.05).
CONCLUSIONS:
The currently available evidence suggests good
efficacy of tamoxifen for the prevention and treatment of breast events induced
by non-steroidal antiandrogens. The impact of tamoxifen therapy on long-term
adverse events, disease progression and survival remains unclear. Further
large, well-designed RCTs, including long-term follow-ups, are warranted. Also,
the optimal dose needs to be clarified.
Source: Tamoxifen for the management
of breast events induced by non-steroidal antiandrogens in patients with
prostate cancer: A systematic review. Kunath F (frank.kunath@uk-erlangen.de),
Keck B, Antes G, Wullich B, Meerpohl JJ. BMC Med. 2012 Aug 28;10(1):96.
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