Letrozole (Page 2 of 9)

5.5 Laboratory Test Abnormalities

No dose-related effect of letrozole on any hematologic or clinical chemistry parameter was evident. Moderate decreases in lymphocyte counts, of uncertain clinical significance, were observed in some patients receiving letrozole 2.5 mg. This depression was transient in about half of those affected. Two patients on letrozole developed thrombocytopenia; relationship to the study drug was unclear. Patient withdrawal due to laboratory abnormalities, whether related to study treatment or not was infrequent.

5.6 Embryo-Fetal Toxicity

Based on post-marketing reports, findings from animal studies and the mechanism of action, letrozole can cause fetal harm and is contraindicated for use in pregnant women. In post-marketing reports, use of letrozole during pregnancy resulted in cases of spontaneous abortions and congenital birth defects. Letrozole caused embryo-fetal toxicities in rats and rabbits at maternal exposures that were below the maximum recommended human dose (MHRD) on a mg/m 2 basis. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during therapy with letrozole and for at least 3 weeks after the last dose [see Adverse Reactions ( 6.2), Use in Specific Populations ( 8.1, 8.3) and Clinical Pharmacology ( 12.1)].

6 ADVERSE REACTIONS

The following adverse reactions are discussed in greater detail in other sections of the labeling.

  • Bone effects [see Warnings and Precautions ( 5.1)]
  • Increases in cholesterol [see Warnings and Precautions ( 5.2)]
  • Fatigue and Dizziness [see Warnings and Precautions ( 5.4)]

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reactions rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adjuvant Treatment of Early Breast Cancer

In study, BIG 1-98, the median treatment duration of adjuvant treatment was 60 months and the median duration of follow-up for safety was 96 months for patients receiving letrozole and tamoxifen.

Certain adverse reactions were prospectively specified for analysis (see Table 1), based on the known pharmacologic properties and side effect profiles of the two drugs.

Adverse reactions were analyzed irrespective of whether a symptom was present or absent at baseline. Most adverse reactions reported (approximately 75% of patients who reported AEs) were Grade 1 or Grade 2 applying the Common Toxicity Criteria (CTC) Version 2.0/ Common Terminology Criteria for Adverse Events (CTCAE), Version 3.0. Table 1 describes adverse reactions (Grades 1-4 and Grades 3-4) irrespective of relationship to study treatment in the adjuvant trial for the monotherapy arms analysis (safety population).

Table 1: Patients with Adverse Reactions (CTC Grades 1-4) in the Adjuvant Study – Monotherapy Arms Analysis (Median Follow-up 96 Months; Median Treatment 60 Months)
Grades 1-4 Grades 3-4
Adverse Reactions Letrozole Tablets N=2448 n (%) Tamoxifen N=2447 n (%) Letrozole Tablets N=2448 n (%) Tamoxifen N=2447 n (%)
Patients with any adverse reaction 2309 (93.4) 2212 (90.4) 636 (26.0) 606 (24.8)
Hypercholesterolemia * 1280 (52.3) 700 (28.6) 11 ( 0.4) 6 ( 0.2)
Hot flashes * 819 (33.5) 929 (38.0)
Arthralgia/Arthritis * 621 (25.4) 504 (20.6) 84 ( 3.4) 50 ( 2.0)
Bone fractures 1 361 (14.7) 280 (11.4)
Night sweats * 356 (14.6) 426 (17.4)
Weight Increase * 317 (12.9) 378 (15.4) 27 ( 1.1) 39 ( 1.6)
Nausea * 284 (11.6) 277 (11.3) 6 ( 0.2) 9 ( 0.4)
Bone Fractures **2 249 (10.2) 175 ( 7.2)
Fatigue (lethargy, malaise, asthenia) **2 235 ( 9.6) 250 (10.2) 6 ( 0.2) 7 ( 0.3)
Myalgia * 221 ( 9.0) 212 ( 8.7) 18 ( 0.7) 14 ( 0.6)
Vaginal Bleeding * 129 ( 5.3) 320 (13.1) 1 (<0.1) 8 ( 0.3)
Edema * 164 ( 6.7) 160 ( 6.5) 3 ( 0.1) 1 (<0.1)
Weight decrease 140 ( 5.7) 129 ( 5.3) 8 ( 0.3) 5 ( 0.2)
Osteoporosis ** 126 ( 5.1) 66 ( 2.7) 10 ( 0.4) 5 ( 0.2)
Back Pain 125 ( 5.1) 136 ( 5.6) 7 ( 0.3) 11 ( 0.4)
Bone pain 123 ( 5.0) 109 ( 4.5) 6 ( 0.2) 4 ( 0.2)
Depression 119 ( 4.9) 114 ( 4.7) 16 ( 0.7) 14 ( 0.6)
Vaginal irritation * 112 ( 4.6) 77 ( 3.1) 2 (<0.1) 2 (<0.1)
Headache * 105 ( 4.3) 94 ( 3.8) 8 ( 0.3) 4 ( 0.2)
Pain in extremity 103 ( 4.2) 79 ( 3.2) 6 ( 0.2) 4 ( 0.2)
Osteopenia * 87 ( 3.6) 76 ( 3.1) 0 3 (0.1)
Dizziness/Light-Headedness * 84 ( 3.4) 80 ( 3.3) 1 (<0.1) 6 (0.2)
Alopecia 83 ( 3.4) 84 ( 3.4)
Vomiting * 80 ( 3.3) 80 ( 3.3) 3 ( 0.1) 5 (0.2)
Cataract * 49 ( 2.0) 54 ( 2.2) 16 ( 0.7) 17 ( 0.7)
Constipation * 49 ( 2.0) 71 ( 2.9) 3 ( 0.1) 1 (<0.1)
Myocardial infarction 1 42 (1.7) 28 (1.1)
Breast pain * 37 ( 1.5) 43 ( 1.8) 1 (<0.1)
Anorexia * 20 ( 0.8) 20 ( 0.8) 1 (<0.1) 1 (<0.1)
Endometrial proliferation disorders * 14 (0.6) 86 (3.5) 0 14 (0.6)
Ovarian cyst * 11 (0.4) 18 (0.7) 4 (0.2) 4 (0.2)
Endometrial hyperplasia/ Cancer **1 11 (0.4) 72 (2.9)
Endometrial hyperplasia/ Cancer **3 6/1909 ( 0.3) 57/1943 (2.9)
Other endometrial disorders ** 2 (<0.1) 3 ( 0.1) 0 0
Myocardial infarction **2 24 ( 1.0) 12 ( 0.5)
Myocardial ischemia 6 ( 0.2) 9 ( 0.4)
Cerebrovascular accident/TIA **1 74 (3.0) 68 (2.8)
Cerebrovascular accident/TIA **2 51 ( 2.1) 47 ( 1.9)
Angina requiring surgery **1 35 ( 1.4) 33 ( 1.3)
Angina requiring surgery **2 25 ( 1.0) 25 ( 1.0)
Thromboembolic event **1 79 ( 3.2) 113 ( 4.6)
Thromboembolic event **2 51 ( 2.1) 89 ( 3.6)
Cardiac failure 1 39 (1.6) 34 (1.4)
Cardiac failure 2 27 (1.1) 15 (0.6)
Hypertension 1 160 (6.5) 175 (7.2)
Hypertension 2 138 (5.6) 139 (5.7)
Other cardiovascular **1 172 (7.0) 174 (7.1)
Other cardiovascular 2 120 (4.9) 119 (4.9)
Second primary malignancy 1 129 (5.3) 150 (6.1)
Second primary malignancy 2 54 ( 2.2) 79 ( 3.2)

* Target events pre-specified for analysis

** Events pre-printed on CRF

1 At median follow-up of 96 months (i.e. any time after randomization) for letrozole tablets (range up to 144 months) and 95 months for tamoxifen (range up to 143 months )

2 At median treatment duration of 60 months (i.e. during treatment + 30 days after discontinuation of treatment) for letrozole tablets and tamoxifen (range up to 68 months)

3 Excluding women who had undergone hysterectomy before study entry TIA = Transient ischemic attack

Note: Cardiovascular events (including cerebrovascular and thromboembolic events), skeletal and urogenital/endometrial events and second primary malignancies were collected life -long. All of these events were assumed to be of CTC Grade 3 to 5 and were not individually graded

When considering all grades during study treatment, a higher incidence of events was seen for letrozole regarding fractures (10.1% vs. 7.1%), myocardial infarctions (1.0% vs. 0.5%), and arthralgia (25.2% vs. 20.4%) (letrozole vs. tamoxifen respectively). A higher incidence was seen for tamoxifen regarding thromboembolic events (2.1% vs. 3.6%), endometrial hyperplasia/cancer (0.3% vs. 2.9%), and endometrial proliferation disorders (0.3% vs. 1.8%) (letrozole vs. tamoxifen respectively).

At a median follow up of 96 months, a higher incidence of events was seen for letrozole (14.7%) than for tamoxifen (11.4%) regarding fractures. A higher incidence was seen for tamoxifen compared to letrozole regarding thromboembolic events (4.6% vs. 3.2%), and endometrial hyperplasia or cancer (2.9% vs. 0.4%) (tamoxifen vs. letrozole, respectively).

Bone Study: Results of a safety trial in 263 postmenopausal women with resected receptor positive early breast cancer in the adjuvant setting comparing the effect on lumbar spine (L2-L4) BMD of adjuvant treatment with letrozole to that with tamoxifen showed at 24 months a median decrease in lumbar spine BMD of 4.1% in the letrozole arm compared to a median increase of 0.3% in the tamoxifen arm (difference = 4.4%) ( P <0.0001). No patients with a normal BMD at baseline became osteoporotic over the 2 years and only 1 patient with osteopenia at baseline (T score of -1.9) developed osteoporosis during the treatment period (assessment by central review). The results for total hip BMD were similar, although the differences between the two treatments were less pronounced. During the 2 year period, fractures were reported by 4 of 103 patients (4%) in the letrozole arm, and 6 of 97 patients (6%) in the tamoxifen arm.

Lipid Study: In a safety trial in 263 postmenopausal women with resected receptor positive early breast cancer at 24 months comparing the effects on lipid profiles of adjuvant letrozole to tamoxifen, 12% of patients on letrozole had at least one total cholesterol value of a higher CTCAE grade than at baseline compared with 4% of patients on tamoxifen. In another postapproval randomized, multicenter, open label, study of letrozole vs anastrozole in the adjuvant treatment of postmenopausal women with hormone receptor and node positive breast cancer (FACE, NCT00248170), the median duration of treatment was 60 months for both treatment arms. Table 2 describes adverse reactions (Grades 1-4 and Grades 3-4) irrespective of relationship to study treatment in the adjuvant study (safety population).

Table 2: Adverse Reactions (CTC Grades 1-4), Occurring in at least 5% of Patients in Either Treatment Arm, by Preferred Term (Safety set)
Adverse Reactions Letrozole N = 2049 n (%) Anastrozole N = 2062 n (%)
Grade 3/4 n (%) All grades n (%) Grade 3/4 n (%) All grades n (%)
Patients with at least one AR 628 (30.6) 2049 (100.0) 591 (28.7) 2062 (100.0)
Arthralgia 80 (3.9) 987 (48.2) 69 (3.3) 987 (47.9)
Hot flush 17 (0.8) 666 (32.5) 9 (0.4) 666 (32.3)
Fatigue 8 (0.4) 345 (16.8) 10 (0.5) 343 (16.6)
Osteoporosis 5 (0.2) 223 (10.9) 11 (0.5) 225 (10.9)
Myalgia 16 (0.8) 233 (11.4) 15 (0.7) 212 (10.3)
Back pain 11 (0.5) 212 (10.3) 17 (0.8) 193 (9.4)
Osteopenia 4 (0.2) 203 (9.9) 1 (0.0) 173 (8.4)
Pain in extremity 9 (0.4) 168 (8.2) 3 (0.1) 174 (8.4)
Lymphoedema 5 (0.2) 159 (7.8) 2 (0.1) 179 (8.7)
Insomnia 7 (0.3) 160 (7.8) 3 (0.1) 149 (7.2)
Hypercholesterolaemia 2 (0.1) 155 (7.6) 1 (0.0) 151 (7.3)
25 (1.2) 156 (7.6) 20 (1.0) 149 (7.2)
Depression 16 (0.8) 147 (7.2) 13 (0.6) 137 (6.6)
Bone pain 10 (0.5) 138 (6.7) 9 (0.4) 122 (5.9)
Nausea 6 (0.3) 137 (6.7) 5 (0.2) 152 (7.4)
Headache 3 (0.1) 130 (6.3) 5 (0.2) 168 (8.1)
Alopecia 2 (0.1) 127 (6.2) 0 (0.0) 134 (6.5)
Musculoskeletal pain 6 (0.3) 123 (6.0) 9 (0.4) 147 (7.1)
Radiation skin injury 11 (0.5) 120 (5.9) 6 (0.3) 88 (4.3)
Dyspnoea 16 (0.8) 118 (5.8) 10 (0.5) 96 (4.7)
Cough 1 (0.0) 106 (5.2) 1 (0.0) 120 (5.8)
Musculoskeletal stiffness 2 (0.1) 102 (5.0) 2 (0.1) 84 (4.1)
Dizziness 2 (0.2) 94 (4.6) 7 (0.3) 109 (5.3)

The following adverse reactions were also identified in less than 5% of the 2049 patients treated with letrozole and not included in the table: fall, vertigo, hyperbilirubinemia, jaundice, and chest pain.

Extended Adjuvant Treatment of Early Breast Cancer, Median Treatment Duration of 24 Months

In study MA-17, the median duration of extended adjuvant treatment was 24 months and the median duration of follow-up for safety was 28 months for patients receiving letrozole tablets and placebo.

Table 3 describes the adverse reactions occurring at a frequency of at least 5% in any treatment group during treatment. Most adverse reactions reported were Grade 1 and Grade 2 based on the CTC Version 2.0. In the extended adjuvant setting, the reported drug-related adverse reactions that were significantly different from placebo were hot flashes, arthralgia/arthritis, and myalgia.

Table 3: Adverse Reactions Occurring in at least 5% of Patients in either Treatment Arm
Number (%) of Patients with Grade 1-4 Adverse Reactions Number (%) of Patients with Grade 3-4 Adverse Reactions
Letrozole Tablets Placebo Letrozole Tablets Placebo
N=2563 N=2573 N=2563 N=2573
Any Adverse Reaction 2232 (87.1) 2174 (84.5) 419 (16.3) 389 (15.1)
Vascular Disorders 1375 (53.6) 1230 (47.8) 59 (2.3) 74 (2.9)
Flushing 1273 (49.7) 1114 (43.3) 3 (0.1) 0 –
General Disorders 1154 (45) 1090 (42.4) 30 (1.2) 28 (1.1)
Asthenia 862 (33.6) 826 (32.1) 16 (0.6) 7 (0.3)
Edema NOS 471 (18.4) 416 (16.2) 4 (0.2) 3 (0.1)
Musculoskeletal Disorders 978 (38.2) 836 (32.5) 71 (2.8) 50 (1.9)
Arthralgia 565 (22) 465 (18.1) 25 (1) 20 (0.8)
Arthritis NOS 173 (6.7) 124 (4.8) 10 (0.4) 5 (0.2)
Myalgia 171 (6.7) 122 (4.7) 8 (0.3) 6 (0.2)
Back Pain 129 (5) 112 (4.4) 8 (0.3) 7 (0.3)
Nervous System Disorders 863 (33.7) 819 (31.8) 65 (2.5) 58 (2.3)
Headache 516 (20.1) 508 (19.7) 18 (0.7) 17 (0.7)
Dizziness 363 (14.2) 342 (13.3) 9 (0.4) 6 (0.2)
Skin Disorders 830 (32.4) 787 (30.6) 17 (0.7) 16 (0.6)
Sweating Increased 619 (24.2) 577 (22.4) 1 (<0.1) 0 –
Gastrointestinal Disorders 725 (28.3) 731 (28.4) 43 (1.7) 42 (1.6)
Constipation 290 (11.3) 304 (11.8) 6 (0.2) 2 (<0.1)
Nausea 221 (8.6) 212 (8.2) 3 (0.1) 10 (0.4)
Diarrhea NOS 128 (5) 143 (5.6) 12 (0.5) 8 (0.3)
Metabolic Disorders 551 (21.5) 537 (20.9) 24 (0.9) 32 (1.2)
Hypercholesterolemia 401 (15.6) 398 (15.5) 2 (<0.1) 5 (0.2)
Reproductive Disorders 303 (11.8) 357 (13.9) 9 (0.4) 8 (0.3)
Vaginal Hemorrhage 123 (4.8) 171 (6.6) 2 (<0.1) 5 (0.2)
Vulvovaginal Dryness 137 (5.3) 127 (4.9) 0 – 0 –
Psychiatric Disorders 320 (12.5) 276 (10.7) 21 (0.8) 16 (0.6)
Insomnia 149 (5.8) 120 (4.7) 2 (<0.1) 2 (<0.1)
Respiratory Disorders 279 (10.9) 260 (10.1) 30 (1.2) 28 (1.1)
Dyspnea 140 (5.5) 137 (5.3) 21 (0.8) 18 (0.7)
Investigations 184 (7.2) 147 (5.7) 13 (0.5) 13 (0.5)
Infections and Infestations 166 (6.5) 163 (6.3) 40 (1.6) 33 (1.3)
Renal Disorders 130 (5.1) 100 (3.9) 12 (0.5) 6 (0.2)

Based on a median follow-up of patients for 28 months,the incidence of clinical fractures from the core randomized study in patients who received letrozole was 5.9% (152) and placebo was 5.5% (142). The incidence of self-reported osteoporosis was higher in patients who received letrozole 6.9% (176) than in patients who received placebo 5.5% (141). Bisphosphonates were administered to 21.1% of the patients who received letrozole and 18.7% of the patients who received placebo.

The incidence of cardiovascular ischemic events from the core randomized study was comparable between patients who received letrozole 6.8% (175) and placebo 6.5% (167).

A patient-reported measure that captures treatment impact on important symptoms associated with estrogen deficiency demonstrated a difference in favor of placebo for vasomotor and sexual symptom domains.

Bone Substudy: [see Warnings and Precautions ( 5.1)].

Lipid Substudy : In the extended adjuvant setting, based on a median duration of follow-up of 62 months, there was no significant difference between letrozole and placebo in total cholesterol or in any lipid fraction at any time over 5 years. Use of lipid lowering drugs or dietary management of elevated lipids was allowed. [see Warnings and Precautions ( 5.2)].

Updated Analysis, Extended Adjuvant Treatment of Early Breast Cancer, Median Treatment Duration of 60 Months

The extended adjuvant treatment trial (MA-17) was unblinded early [see Adverse Reactions ( 6)] . At the updated (final analysis), overall the side effects seen were consistent to those seen at a median treatment duration of 24 months.

During treatment or within 30 days of stopping treatment (median duration of treatment 60 months) a higher rate of fractures was observed for letrozole (10.4%) compared to placebo (5.8%), as also a higher rate of osteoporosis (letrozole 12.2% vs placebo 6.4%).

Based on 62 months median duration of follow-up in the randomized letrozole arm in the safety population the incidence of new fractures at any time after randomization was 13.3% for letrozole and 7.8% for placebo. The incidence of new osteoporosis was 14.5% for letrozole and 7.8% for placebo.

During treatment or within 30 days of stopping treatment (median duration of treatment 60 months) the incidence of cardiovascular events was 9.8% for letrozole and 7.0% for placebo.

Based on 62 months median duration of follow-up in the randomized letrozole arm in the safety population the incidence of cardiovascular disease at any time after randomization was 14.4% for letrozole and 9.8% for placebo.

Lipid Substudy : In the extended adjuvant setting (MA-17), based on a median duration of follow-up of 62 months, there was no significant difference between letrozole and placebo in total cholesterol or in any lipid fraction over 5 years. Use of lipid lowering drugs or dietary management of elevated lipids was allowed. [see Warnings and Precautions( 5.2)]

First-Line Treatment of Advanced Breast Cancer

In study P025 a total of 455 patients were treated for a median time of exposure of 11 months in the letrozole arm (median 6 months in the tamoxifen arm). The incidence of adverse reactions was similar for letrozole and tamoxifen. The most frequently reported adverse reactions were bone pain, hot flushes, back pain, nausea, arthralgia and dyspnea. Discontinuations for adverse reactions other than progression of tumor occurred in 10/455 (2%) of patients on letrozole and in 15/455 (3%) of patients on tamoxifen.

Adverse reactions that were reported in at least 5% of the patients treated with letrozole 2.5 mg or tamoxifen 20 mg in the first-line treatment study are shown in Table 4.

Table 4: Adverse Reactions Occurring in at least 5% of Patients in either Treatment Arm
Adverse Letrozole Tamoxifen
Reactions 2.5 mg 20 mg
(N=455) (N=455)
% %
General Disorders
Fatigue 13 13
Chest Pain 8 9
Edema Peripheral 5 6
Pain NOS 5 7
Weakness 6 4
Investigations
Weight Decreased 7 5
Vascular Disorders
Hot Flushes 19 16
Hypertension 8 4
Gastrointestinal Disorders
Nausea 17 17
Constipation 10 11
Diarrhea 8 4
Vomiting 7 8
Infections/Infestations
Influenza 6 4
Urinary Tract Infection NOS 6 3
Injury, Poisoning and Procedural Complications
Post-Mastectomy Lymphedema 7 7
Metabolism and Nutrition Disorders
Anorexia 4 6
Musculoskeletal and Connective Tissue Disorders
Bone Pain 22 21
Back Pain 18 19
Arthralgia 16 15
Pain in Limb 10 8
Nervous System Disorders
Headache NOS 8 7
Psychiatric Disorders
Insomnia 7 4
Reproductive System and Breast Disorders
Breast Pain 7 7
Respiratory, Thoracic and Mediastinal Disorders
Dyspnea 18 17
Cough 13 13
Chest Wall Pain 6 6

Other less frequent (less than or equal to 2%) adverse reactions considered consequential for both treatment groups, included peripheral thromboembolic events, cardiovascular events, and cerebrovascular events. Peripheral thromboembolic events included venous thrombosis, thrombophlebitis, portal vein thrombosis and pulmonary embolism. Cardiovascular events included angina, myocardial infarction, myocardial ischemia, and coronary heart disease. Cerebrovascular events included transient ischemic attacks, thrombotic or hemorrhagic strokes and development of hemiparesis.

Second- Line Treatment of Advanced Breast Cancer

Study discontinuations in the megestrol acetate comparison study (AR/BC2) for adverse reactions other than progression of tumor were 5/188 (2.7%) on letrozole 0.5 mg, in 4/174 (2.3%) on letrozole 2.5 mg, and in 15/190 (7.9%) on megestrol acetate. There were fewer thromboembolic events at both letrozole doses than on the megestrol acetate arm (0.6% vs 4.7%). There was also less vaginal bleeding (0.3% vs 3.2%) on letrozole than on megestrol acetate. In the aminoglutethimide comparison study (AR/BC3), discontinuations for reasons other than progression occurred in 6/193 (3.1%) on 0.5 mg letrozole, 7/185 (3.8%) on 2.5 mg letrozole, and 7/178 (3.9%) of patients on aminoglutethimide.

Comparisons of the incidence of adverse reactions revealed no significant differences between the high and low dose letrozole groups in either study. Most of the adverse reactions observed in all treatment groups were mild to moderate in severity and it was generally not possible to distinguish adverse reactions due to treatment from the consequences of the patient’s metastatic breast cancer, the effects of estrogen deprivation, or intercurrent illness.

Adverse reactions that were reported in at least 5% of the patients treated with letrozole 0.5 mg, letrozole 2.5 mg, megestrol acetate, or aminoglutethimide in the two controlled trials AR/BC2 and AR/BC3 are shown in Table 5.

Table 5: Adverse Reactions Occurring at a Frequency of at Least 5% of Patients in Either Treatment Arm
Adverse Pooled Pooled megestrol
Reactions Letrozole Letrozole acetate aminoglutethimide
2.5 mg 0.5 mg 160 mg 500 mg
(N=359) (N=380) (N=189) (N=178)
% % % %
Body as a Whole
Chest Pain 6 3 7 3
Peripheral Edema 1 5 5 8 3
Asthenia 4 5 4 5
Weight Increase 2 2 9 3
Cardiovascular
Hypertension 5 7 5 6
Digestive System
Nausea 13 15 9 14
Vomiting 7 7 5 9
Constipation 6 7 9 7
Diarrhea 6 5 3 4
Pain-Abdominal 6 5 9 8
Anorexia 5 3 5 5
Dyspepsia 3 4 6 5
Infections/Infestations
Viral Infection 6 5 6 3
Lab Abnormality
Hypercholesterolemia 3 3 0 6
Musculoskeletal System
Musculoskeletal 2 21 22 30 14
Arthralgia 8 8 8 3
Nervous System
Headache 9 12 9 7
Somnolence 3 2 2 9
Dizziness 3 5 7 3
Respiratory System
Dyspnea 7 9 16 5
Coughing 6 5 7 5
Skin and Appendages
Hot Flushes 6 5 4 3
Rash 3 5 4 3 12
Pruritus 1 2 5 3

1 Includes peripheral edema, leg edema, dependent edema, edema

2 Includes musculoskeletal pain, skeletal pain, back pain, arm pain, leg pain

3 Includes rash, erythematous rash, maculopapular rash, psoriasiform rash, vesicular rash

Other less frequent (less than 5%) adverse reactions considered consequential and reported in at least 3 patients treated with letrozole, included hypercalcemia, fracture, depression, anxiety, pleural effusion, alopecia, increased sweating and vertigo.

First and Second-Line Treatment of Advanced Breast Cancer

In the combined analysis of the first- and second-line metastatic trials and postmarketing experiences other adverse reactions that were reported were cataract, eye irritation, palpitations, cardiac failure, tachycardia, dysesthesia (including hypesthesia/paresthesia), arterial thrombosis, memory impairment, irritability, nervousness, urticaria, increased urinary frequency, leukopenia, stomatitis cancer pain, pyrexia, vaginal discharge, appetite increase, dryness of skin and mucosa (including dry mouth), and disturbances of taste and thirst.

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