Anemia of Unknown Origin in an 80-Year-Old Woman

Kathy D. Miller, MD; Jill Kremer, MD


July 30, 2015

Multiple options for additional hormone therapy are available, all with documented activity after progression on an aromatase inhibitor. The choice of hormone therapy can be individualized on the basis of patient-specific concerns for toxicity, mode of administration, and cost. The addition of everolimus to tamoxifen is supported by data from the TAMRAD study.[4] In this randomized, phase 2 trial, the combination increased clinical benefit rate from 42% to 61% and increased time to progression from 4.5 months to 8.6 months compared with tamoxifen alone. The addition of everolimus also increased toxicity, particularly fatigue (72% vs 53% with tamoxifen alone), stomatitis (56% vs 7%), rash (44% vs 7%), anorexia (43% vs 18%), and diarrhea (39% vs 11%).

More recently, the PALOMA3 trial evaluated the compared the efficacy of fulvestrant alone or with the cyclin-dependent kinase 4/6 inhibitor palbociclib n patients who had progressed on prior endocrine therapy.[5] PALOMA3 enrolled 521 patients; 60% had visceral disease at study entry. Clinical benefit increased from 19% to 34%, and progression-free survival improved from 3.8 to 9.3 months. Palbociclib does induce myelosuppression with grade > 3 neutropenia in 62% of patients, although infections were uncommon (< 2%). Less than 3% of patients discontinued palbociclib because of toxicity.


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