Patients given exemestane show higher risk of Carpal Tunnel Syndrome

According to an international study in Lancet Oncology, the risk of carpal tunnel syndrome is higher in patients who suffer from breast cancer and are given exemestane than the patients who are administered tamoxifen. Aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring, but this is at the expense of side effects such as carpal tunnel syndrome. The study was aimed at studying and assessing the risk factors involved and the prognostic value of musculoskeletal symptoms in the course of treatment with the steroidal aromatase inhibitor exemestane or with tamoxifen after 2—3 years of tamoxifen.

In the Intergroup Exemestane Study, women who have had menopause were treated for nearly invasive breast cancer that was disease free. On being administered tamoxifen for almost 2 to 3 years they were randomized to switch to exemestane or to continue tamoxifen for the remaining period in the 5 year period of endocrine treatment. In this retrospective analysis the primary endpoint was occurrence of carpal tunnel syndrome any other musculoskeletal events. This was analysed in the safety population, this population consisted of all patients who had received any trial treatment. Questionnaires and case report forms were distributed to gain more details about cases of carpal tunnel syndrome.
Carpal Tunnel Syndrome

After a follow up of 91.0 months the study found that carpal tunnel syndrome has been reported for 66 of 2319 patients in the exemestane group. This number represents 2.8% of the patients. In the tamoxifen group 13 of 2338 patients had carpal tunnel syndrome. This represented 0.6% of the patients in the tamoxifen group. More events occurred in the exemestane group as compared to the tamoxifen group. No significant difference was observed in the groups in the post treatment period. Out of 73 patients of on-treatment for carpal tunnel syndrome, 58 completely filled questionnaires were available.

27 patients had bilateral carpal tunnel syndrome and 31 patients were reported to have unilateral disease. 40 patients, which are equal to 69% of the patients, underwent surgical release. The results of the study were interpreted and it was concluded that development of musculoskeletal symptoms in the first six months of the period of treatment cannot be considered to be an independent biomarker of improved disease outcome. Further investigation is necessary into the relationship between musculoskeletal symptoms which are basically treatment-emergent in nature and clinical outcome in patients with breast cancer who are given hormonal therapy.

Patients given exemestane show higher risk of Carpal Tunnel Syndrome
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