For some breast cancer survivors, a drug can reduce joint pain related to the treatment

For some breast cancer survivors, a drug can reduce joint pain related to the treatment

A drug that is most commonly used to treat depression can also reduce joint pain in some women who receive treatment for early-stage breast cancer, according to the results of a randomized clinical trial.

After undergoing treatment for early stage breast cancer, many postmenopausal women take medications known as aromatase inhibitors to reduce the risk of cancer recurrence. However, these drugs can cause significant pain in the joints and muscles of women.

The clinical study Output Report showed that duloxetine (Cymbalta®), which was approved to treat depression and anxiety, as well as fibromyalgia and nerve pain caused by diabetes, provided some pain relief associated with aromatase inhibitors .

"Joint and muscle pain can cause some patients to stop treatment with these life-saving drugs," said Dr. Lynn N. Henry of the Huntsman Cancer Institute at the University of Utah, who led the study. To our results, duloxetine seems to be an effective drug for some patients who experience this pain. "

Dr. Henry presented the findings of the study, which was conducted by the SWOG clinical study group, funded by the NCI, at the San Antonio Breast Cancer Symposium on December 9.
Need for new strategies

The body uses an enzyme called aromatase to produce estrogen. It has been found that drugs that block the activity of this enzyme, called aromatase inhibitors, reduce the risk of cancer recurrence in postmenopausal women whose breast tumors depend on estrogen to fuel their growth.

But many of the patients who take these medications experience pain in the knees, hips, hands and wrists, which can make daily tasks difficult. About 20% of patients discontinue the use of aromatase inhibitors due to side effects, according to Dr. Henry. She noted that patients are generally advised to take aromatase inhibitors for 5 or 10 years, so new strategies are needed to control side effects.

For the study of duloxetine, the researchers enrolled 299 women in 43 sites of the NCI Community Oncology Research Program (NCORP) in the United States. The women had received treatment with aromatase inhibitors for early-stage breast cancer and had joint pain caused by the treatment. Women were assigned to receive a 12-week regimen of duloxetine or a placebo.

The participants completed the questionnaires about joint pain, depression and quality of life, at the beginning of the study, and then again after 2, 6, 12 and 24 weeks. The pain questionnaire used a scale of 0 to 10; The researchers defined a clinically significant change in average pain as a decrease of 2 or more points from the time the patient entered the study.
Pain reduction with duloxetine and placebo

In the first 12 weeks of the study, the pain scores of women in the duloxetine group decreased an average of 0.82 points higher than those in the placebo group. Other measures, including the worst pain, joint pain and stiffness, decreased similarly.

For the duloxetine group, the average pain score decreased from 5.44 as a base to 2.91 at 12 weeks. But the average pain score also decreased in the placebo group during the same period, from 5.49 to 3.45. Both reductions were clinically significant, according to the study guidelines.

The conclusion of the strong placebo effect in the control group was not completely unexpected, Dr. Henry said. Other studies of pain treatments have reported similar effects, although the reasons are unclear. "This study demonstrates the need for more research" on the placebo response, she added.






At 12 weeks, 69% of the patients in the duloxetine group and 60% of the patients in the placebo had a 2-point improvement in pain compared to what they had before starting treatment. At 24 weeks, ie 12 weeks after the patients had stopped taking duloxetine or placebo, the average pain score was similar for the groups (3.37 in the duloxetine group and 3.42 for the group of placebo).

The most common side effects of duloxetine were nausea, fatigue and dry mouth, which is consistent with other studies related to the drug.
Exploration of multiple approaches

"These results from the duloxetine study are very promising," says Dr. Ann O'Mara, of the NCI Division of Cancer Prevention, who was not involved in the study. "Duloxetine is the first drug to show a benefit this group of patients in a large randomized clinical trial. "

Dr. O'Mara suggested that patients taking aromatase inhibitors may ultimately need multiple approaches to controlling their pain. Exercises such as walking and acupuncture are the various strategies that are being studied as ways to reduce pain, she said.

"Doctors need to explain to their patients the possible side effects of duloxetine, but this drug can help patients reduce their pain and get back on well," she added.
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