Mitigating Toxicities With Oral SERDs and Other Breast Cancer Therapies

Seth Wander, MD, PhD, a medical oncologist at the Massachusetts General Hospital and instructor in medicine at Harvard Medical School, discusses his experiences with the well-tolerated nature of selective estrogen receptor degraders (SERDs) and next-generation oral anti-estrogen agents in patients with breast cancer.

Wander notes that these drugs may have fewer menopausal symptoms and arthralgia compared to aromatase inhibitors (Ais). Options such as lifestyle interventions, acupuncture, and graded exercise are available for managing adverse events like hot flashes and joint pain. When using AI therapy, the use of non-hormonal medications such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or Gabapentin are also options. Although gastrointestinal (GI) toxicity can occur with SERDs, it hasn't been dose-limiting in Wander’s experience, unlike with older anti-estrogens, where patients often had to discontinue treatment.

TRANSCRIPTION

0:09 | What we're learning about this whole class of drugs, oral SERDs in general and next-generation oral anti-estrogen agents, [is] that they're very well tolerated. That's not particularly surprising. We have decades of experience with AIs, SERMs [selective estrogen receptor modulators], and the injectable SERD fulvestrant [Faslodex]. If anything, in my anecdotal experience in my own clinic, I think these oral SERDs may be better tolerated than, for example, the AIs, perhaps with less menopausal-type symptoms and arthralgia. Many of the same tools that we can use for patients on AI therapy or patients on SERM therapy, I think would come into play here, right? We have a lot of supportive maneuvers for hot flashes and joint pain. Some of those are lifestyle-type interventions: acupuncture, graded exercise, things like that.

0:53 | Otherwise, we have supportive, non-hormonal–type medications. For example, we often use SNRI therapy or Gabapentin for patients who are on AIs. And again, we'll review with our pharmacy colleagues what medication the patients are on and what sort of resources we might want to put into place. The GI toxicity that I mentioned that you can see with some of these oral SERDs might be a little bit more than what we see with traditional anti-estrogens. But in my own, again, anecdotal experience, having given a lot of these drugs, I haven't found it to be dose limiting. I haven't found patients having to come off treatment, to nearly the same extent as what we experienced with some of the older anti-estrogens that we've been used to using.