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Raloxifene vs. Tamoxifen in Reducing Risk for Invasive Breast Cancer

Both of these drugs appear to have advantages and disadvantages.

Tamoxifen therapy reduces risk for breast cancer, and raloxifene therapy reduces risk for invasive breast cancer when it is used to prevent or treat osteoporosis.

In a multisite trial, investigators randomized 19,747 postmenopausal women (mean age, 59) with high risk for breast cancer to receive daily tamoxifen (20 mg) or raloxifene (60 mg). Patients with previous malignancies, risk for thromboembolic disease, and other serious chronic diseases were excluded. During a mean follow-up of 4 years, 331 cases of invasive breast cancer were diagnosed, roughly equally split between the tamoxifen and raloxifene groups. The raloxifene group had a nearly significant higher risk for noninvasive breast cancer than the tamoxifen group did (relative risk, 1.4), and significantly lower risk for thromboembolic events (RR, 0.7). The incidences of osteoporosis, other types of cancer, ischemic heart disease, and stroke were similar in the groups.

In a companion study, no differences were found between the two groups in overall quality of physical and mental health, but the tamoxifen group had significantly more gynecologic problems, vasomotor symptoms, leg cramps, and bladder problems, whereas the raloxifene group had more musculoskeletal pain, dyspareunia, and weight gain.

Comment: Although these data do not point to one selective estrogen-receptor modulator being clearly better than the other, they will help patients make more informed choices about the benefits and adverse effects of these two drugs.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine July 7, 2006

Citation(s):

Vogel VG et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006 Jun 21; 295:2727-41.

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Land SR et al. Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006 Jun 21; 295:2742-51.

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Gradishar WJ and Cella D. Selective estrogen receptor modulators and prevention of invasive breast cancer. JAMA 2006 Jun 21; 295:2784-6.

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• Medline abstract (Free)