Aromatase inhibitors for premenopausal women with ER positive breast cancer

Aromatase inhibitors could better protect against recurrent breast cancer in premenopausal women on ovarian suppression than tamoxifen, new research suggests.

A meta-analysis of four trials involving 7,030 women on ovarian function suppression, with early-stage oestrogen receptor- (ER) positive breast cancer found those on aromatase inhibitors such as anastrozole, exemestane or letrozole were 3% less likely to have recurrent breast cancer at 5- and 10-years follow-up versus tamoxifen-users.

They were also less likely to see distant recurrence, so that, even though the current, limited-duration study (median follow-up 8 years) didn’t see a difference in all-cause mortality between drug arms, “it would be premature to conclude that survival is not improved with aromatase inhibitors”.

While the drug may help stave-off breast cancer’s return, clinicians and patients should weigh the benefits against side-effects and the impact of endocrine therapy and ovarian function suppression on quality of life, read the paper, published in The Lancet Oncology.

It noted that patients on aromatase inhibitors had a higher risk of bone fractures, (rate ratio: 1.27, 95% CI: 1.04–1.54, P = 0.017), although bisphosphates could help mitigate this issue.

“Using an aromatase inhibitor rather than tamoxifen in premenopausal women receiving ovarian suppression reduces the risk of breast cancer recurrence.”

“Longer follow-up is needed to assess any impact on breast cancer mortality,” the paper concluded.

Checkpoint inhibitors promising in cSCC with PNS

A Queensland case series adds to the growing evidence for immunotherapy in the management of challenging head and neck cutaneous squamous cell carcinoma (cSCC) with large nerve perineural spread (PNS).

A retrospective review of 13 patients with PNS at the Princess Alexandra Hospital found an objective response to anti-PD-1 checkpoint inhibitor therapy in nine patients (69%), with complete response in 46% and a partial response in 23%.

Median time to response was 2.1 months while median time to progression in non-responders was 3.5 months.

“With appropriate patient selection, immunotherapy has potential to minimize surgical morbidity and the challenges of reconstruction,” the study said.

“However, this must be considered against the risks and benefits, including disease progression if given prior to surgery.”

Read more in Head & Neck

Male doctors won’t shed facial hair for N95 masks

Almost half the male hospital staff required to wear a P2/N95 respirator during the COVID-19 pandemic have beards or facial hair that would potentially render them ineffective, an audit carried out in a Victorian tertiary centre has found.

Despite successfully completing fit testing with a clean shaven face in the preceding year, 45% of the 110 male staff working in three critical areas of a hospital (ICU, ED and operating theatres) were observed to have beards or to not be clean shaven in the face seal zone of their respirators.

The study authors said it was imperative that clinical staff were clean shaven in the face seal zone of their respirators so they are fit-for-purpose and ready to respond during periods of significant community transmission of COVID-19.

“Health care organisations allowing employees to have facial hair where N95 protection is required may be breaching their duty of care under OHS laws,” they said.

Male staff “experiencing a loss of identity or significant skin irritation with daily shaving should be supported so that their respiratory protection is optimised, not only to protect themselves from harm, but also to safeguard those they work with and care for,” they added.

Read more in Infection, Disease & Health