You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

COVID-19: Get the latest updates or take a self-assessment.

ANAS

Cancer Type: Breast  Intent: Palliative
Regimen Category: Evidence-Informed
Funding:
ODB Limited Use
    anastrozole - For the treatment of metastatic breast cancer in hormone receptor positive post-menopausal women
A - Regimen Name

ANAS Regimen
Anastrozole


Disease Site
Breast

Intent
Palliative

Regimen Category
Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.


Rationale and Uses

Hormonal treatment of advanced breast cancer in postmenopausal women


Supplementary Public Funding

anastrozole
ODB Limited Use (anastrozole - For the treatment of metastatic breast cancer in hormone receptor positive post-menopausal women) (ODB Formulary)

 
B - Drug Regimen

anastrozole
1 mg PO Daily

(Outpatient prescription in 1mg tablets)

 

 
back to top
 
C - Cycle Frequency

CONTINUOUS TREATMENT

Until disease progression or unacceptable toxicity

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Not applicable

Other Supportive Care:

For more information about bone health via dietary and lifestyle measures, see pamphlet on Bone Health in Post-Menopausal Women.
 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations have been adapted from clinical trials or product monographs and could be considered.

 

 

 

Dosage with toxicity

Toxicity

Action

Myelosuppression

No adjustment required

Severe hypercalcemia

Hold; discontinue if recurs



Hepatic Impairment

Clearance is reduced by 30% in patients with cirrhosis, but plasma levels are within normal range; no adjustment is required in mild to moderate hepatic impairment. Anastrozole has not been studied in patients with severe hepatic impairment - use with caution.


Renal Impairment

Clearance is reduced by 50% in severe renal impairment. However, renal excretion is a minor route of excretion and no adjustment is required.


 
F - Adverse Effects
Refer to anastrozole drug monograph(s) for additional details of adverse effects

           Most Common Side Effects                                                                                                  

Less Common Side Effects, but may be
Severe or Life-Threatening
       
  • Estrogen withdrawal  symptoms
  • Nausea/vomiting
  • Fatigue
  • Musculoskeletal pain
  • Osteoporosis / fractures
  • Mood disturbances
  • Rash (may be severe)
  • Hypercholesterolemia
  • Arterial and venous thromboembolism
  • Ischemic cardiovascular events
  • Endometrial cancer
  • Hypercalcemia
  • Vasculitis
  • Hypersensitivity
  •  ↑ LFTs
 
G - Interactions
Refer to anastrozole drug monograph(s) for additional details
 
H - Drug Administration and Special Precautions

Refer to anastrozole drug monograph(s) for additional details

 

 
I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

  • Bone mineral density for patients at risk; baseline and routine
  • Clinical toxicity assessment for fatigue, musculoskeletal, estrogen withdrawal symptoms, rash, edema, thromboembolism, cardiovascular, GI and GU effects, etc.; baseline and routine
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

  • Cholesterol and lipid evaluation; baseline and regular
  • Electrolytes, including calcium; baseline and as clinically indicated
  • Liver function tests; baseline and as clinically indicated

back to top
 
J - Administrative Information
Outpatient prescription for home administration.

 
K - References

Nabholtz JM, Buzdar A, Pollak M, et al. Anastrozole is superior to Tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. J Clin Oncol, 2000;18(22):3758-67.

Bonneterre J, Buzdar A, Nabholtz JM et al. Anastrozole is Superior to Tamoxifen as First-Line Therapy in Hormone Receptor Positive Advanced Breast Carcinoma. Cancer 2001; 92(9):2247-58.

Bonneterre J, Thürlimann BJK, Robertson JFR et al. Anastrozole Versus Tamoxifen as First-Line Therapy for Advanced Breast Cancer in 668 Postmenopausal Women: Results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability Study. Journal of Clin Oncology 2000; 18(22):3748-57.

Buzdar A, Jonat W, Howell A, et al. Anastrozole, a potent and selective aromatase inhibitor, versus megestrol acetate in postmenopausal women with advanced breast cancer: results of overview analysis of two phase III trials. J Clin Oncol, 1996 July;14(7):2000-11.

Buzdar A, Jonat W, Howell A, Jones SE, et al. Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Cancer 1998;83(8):1142-52.

May 2019 Updated emetic risk category


back to top
 
M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.