A Brief Introduction to Aromatase Inhibitors

A triple board-certified physician specializing in hematology and oncology, Natasha Tiffany, MD, serves as a partner and practicing physician at Hematology Oncology of Salem in Salem, Oregon. Natasha Tiffany, MD, and the medical staff at Hematology Oncology of Salem utilize the latest cancer treatments, therapies, and medications, including aromatase inhibitors.

Aromatase inhibitors are a newer class of drugs that are often used to treat breast cancer or prevent its recurrence following surgery in postmenopausal women. Drugs in this class, which include letrozole, anastrozole, and exemestane, work by inhibiting the action of aromatase, the enzyme responsible for converting androgen into estrogen. These drugs are particularly effective in treating estrogen receptor-positive (ER+) breast cancers because they reduce the amount of available estrogen, which these types of cancers need to grow.

Either used alone or in combination with other drugs, aromatase inhibitors have been shown to be an effective treatment for both early and metastatic or recurring ER+ breast cancer. These drugs are also often prescribed off-label to treat conditions such as infertility and endometriosis. While they tend to be milder than other cancer drugs, the most common side effects of aromatase inhibitors include joint pain or stiffness, hot flashes, and bone thinning.

Genetically Targeted, Personalized Cancer Treatments Increasingly Available

Cancer treatments are rapidly evolving. Traditional chemotherapy targets rapidly replicating cells. This kills the cancer cells, but can also lead to side effects such as hair loss, nausea and vomiting because the hair cells and the cells lining the gastrointestinal tract also divide quickly.

In recent years, scientists have been designing targeted treatments that are designed to block pathways needed for cancer cells to replicate and survive. Many cancer cells have genetic mutations in them that drive tumor growth. If we can identify a driving mutation in a tumor, we can design treatments that shut down the pathway it uses to promote cell division and survival. This targeted approach often has fewer side effects than traditional chemotherapy.

This personalized cancer therapy is very promising. We are committed to providing our patients the most up to date and cutting edge treatments available. We may talk to you about doing genetic testing of your tumor to see if you might benefit from targeted therapy.

Currently, many of the targeted treatments are available only through clinical trials, but some are already available as standard of care. We can help you find the best treatment options for you. If you have questions about personalized cancer treatments, please talk to your oncologist.

Understanding Targeted Cancer Therapies

Natasha Tiffany, MD, administers innovative cancer treatments, such as targeted therapy, through Hematology Oncology of Salem, LLP, in Salem, Oregon. In preparation for her career, she underwent fellowship training in modern cancer care through Oregon Health and Science University. Before deciding whether to pursue targeted cancer therapy, patients ought to consult with an experienced professional like Natasha Tiffany, MD.

A relatively new treatment method, targeted therapy encompasses those medications that hone in on and influence specific molecules that regulate the growth and overall survival of cancer cells. Such methods are distinct from traditional chemotherapy, which does damage to both healthy and malignant cells. Currently, there is a range of targeted therapies available, including those that rely on hormones to treat hormone-sensitive growths and those that trigger controlled cell death in tumors.

For an oncologist to consider targeted therapy as a possible option, the patient in question needs to have a cancer that matches the available therapies. This may require that patients undergo genetic testing to see if their tumor cells actually have the necessary molecules for the therapy to target.

Natasha Tiffany, MD: Aromatase Inhibitors for Treating Early-Stage Breast Cancer

A cum laude graduate of Oregon Health and Science University, Natasha Tiffany, M.D., practices with Hematology Oncology of Salem. She has a professional interest in breast cancer therapy and prescribes aromatase inhibitors such as anastrozole and letrozole in treating certain patients. A newer type of medication, aromatase inhibitors are used by postmenopausal women to halt harmful estrogen production by the aromatase enzyme.

Without the inhibitor, aromatase turns androgen into small amounts of estrogen, which in turn stimulates the growth of breast cancer cells that are hormone-receptor-positive. This treatment approach is distinct from drugs such as raloxifene and tamoxifen, which work by blocking the estrogen receptors. Several studies have compared aromatase inhibitors and tamoxifen. Breastcancer.org notes that aromatase inhibitors typically are recommended as the best hormonal treatment to begin with, particularly among early-stage breast cancer patients who have undergone surgery (and in some cases radiation therapy and chemotherapy). The reason is that aromatase inhibitors appear to have fewer serious side effects, and more benefits overall, than their tamoxifen counterparts.

Natasha Tiffany, M.D.: A Brief Overview of Breast Cancer Hormone Therapy Drug Tamoxifen

Natasha Tiffany, M.D., of Hematology Oncology of Salem, LLP, possesses 15 years of post-doctoral training and professional experience. Board-certified in internal medicine, medical oncology, and hematology, Dr. Tiffany became a physician partner at Hematology Oncology of Salem, in Salem, OR, in 2005. She holds a medical degree from Oregon Health & Science University.

Used in breast cancer related hormone therapy for pre- and post-menopausal patients, the anti-estrogen drug tamoxifen works by blocking the estrogen receptors found on breast cancer cells, thus preventing estrogen from binding to the cells and stimulating their growth. Taken daily in tablet or liquid form, tamoxifen decreases the recurrence of early stage breast cancer and treats metastatic breast cancer. Additionally, tamoxifen is effective in reducing the incidence of breast cancer in high-risk patients.

Women and men using tamoxifen may experience common, occasional, and rare side effects. About 10 in every 100 patients on tamoxifen report at least one common side effect, such as hot flushes and sweats, fatigue, and irregular periods. Occasional side effects include vaginal discharge, vaginal dryness, weight gain, headaches, and depression. Lastly, rare adverse effects include skin rashes, uterine cancer, blood clots and stroke. The risk of uterine cancer and stroke are greatest in post-menopausal women. Women taking tamoxifen who have not had a hysterectomy need to report any unusual vaginal bleeding, and require yearly pelvic exams.

Interview with Natasha Tiffany, MD (Part I)

Natasha Tiffany, MD, currently provides a range of cancer treatments to patients at Hematology Oncology of Salem in Salem, Oregon, where she has worked since 2004. We recently sat down with Dr. Tiffany to discuss her work and the types of cancer therapies she offers to patients.

Can you tell us a little bit about some of the research that you have conducted over the course of your career?
Natasha Tiffany, MD: Of course. For two years in the early 2000s, I worked with Dr. Tomasz Beer studying the effectiveness of two drugs, Zometa and Gleevec, on androgen-independent prostate cancer. With Dr. Beer, I have also published research on the effects of Docetaxel, Calcitriol, and Estramustine in androgen-independent prostate cancer. I have participated in the research of multiple myeloma, as well. My earlier research was in neurology, particularly looking at stroke and Parkinson’s disease.

You also have been involved in cancer research through other professional activities. Can you discuss some of those?
Natasha Tiffany, MD: At the Salem Cancer Institute, we are building our clinical trials program so we can offer cutting-edge treatments to patients that have not yet been FDA approved. I believe clinical research is vital to the future of cancer treatments, and it can offer important drugs that patients otherwise would not have been able to receive. We are hoping to have a clinical trial available for each of the major stages of most cancers so that we can offer these trials to those patients who are interested. I serve on the Board of Directors for Willamette Clinical Research and am a member of the Southwest Oncology Group, which designs and funds clinical trial.