Prostate news article, September 2005
| TAMOXIFEN IS
BETTER THAN RADIOTHERAPY FOR BICALUTAMIDE INDUCED BREAST SIDE
EFFECTS
Perdona S, Autorino R, De Placido S et al. Article in Lancet Oncology 2005 May;6(5):295-300. Reviewed by: Dr Charlotte Foley MA BMBCh MRCS |
Efficacy of tamoxifen and radiotherapy for prevention and treatment of gynaecomastia and breast pain caused by bicalutamide in prostate cancer: a randomised controlled trial.
Bicalutamide (Casodex®) may be prescribed at various stages of prostate cancer to better control the disease. Unfortunately, men commonly develop painful and/or enlarged breasts (gynaecomastia) when started on this drug, as the balance of oestrogen to testosterone in the body is upset. These side effects can be bad enough that the drug is stopped. Of over 4000 patients receiving bicalutamide in a recent trial, 74% developed painful breasts and 68% noticed breast enlargement, with 17% stopping the drug.
We know that delivering a small dose of radiation to the breast or giving patients tamoxifen (a drug that inhibits oestrogen effects) can help settle these symptoms. A new study from Italy published in the Lancet has compared these two interventions in a small but elegant trial. They compared the incidence of both complications in 51 prostate cancer patients treated with bicalutamide alone, 50 also treated with tamoxifen from the outset, and 50 given breast radiotherapy on the day of starting the drug. It was clear that tamoxifen was better than radiotherapy for preventing the breast side effects of bicalutamide, and it was also effective at treating the established breast symptoms developed by 35 of the first group of 51 men while radiotherapy was not.
A note of caution is sounded by the authors who point out that we don’t know whether tamoxifen interferes with the effectiveness of the prostate cancer treatment, though no such impact was seen.