A Food and Drug Administration advisory panel has recommended that raloxifene be approved to reduce the risk of invasive breast cancer in postmenopausal women who have osteoporosis or who are at high risk of breast cancer.
The Oncologic Drugs Advisory Committee on July 24 recommended approval of raloxifene, a selective estrogen receptor modulator. The drug was originally approved by the FDA in 1997 to prevent and treat osteoporosis in postmenopausal women.
More than 52 million prescriptions for raloxifene have been filled since its approval, according to a statement from Eli Lilly and Company, which markets the drug as Evista.
Using data gathered from 37,000 postmenopausal women over a 10-year period, Eli Lilly submitted a new drug application to the FDA in 2006 to extend the drug's use to reducing breast cancer risk in this same group of patients.
If approved, Evista would be the “first and only therapy available to address two leading health issues for postmenopausal women—osteoporosis and breast cancer,” Gwen Krivi, Ph.D., vice president of Lilly Research Laboratories, said in a written statement.
Although the committee voted to approve the indication for breast cancer risk reduction in postmenopausal women with osteoporosis (8 to 6) and in postmenopausal women at high risk for breast cancer (10 to 4), the agency is not obligated to approve these new indications.
The advisory committee reviewed four large studies also submitted in the application: The Study of Tamoxifen and Raloxifene (STAR) trial; Raloxifene Use for the Heart (RUTH) trial; Multiple Outcomes of Raloxifene Evaluation (MORE); and the Continuing Outcomes Relevant to Evista (CORE) trials.
Dr. Wulf Utian, executive director of the North American Menopause Society, said in an interview that the advisory committee's decision was a positive step that “increases the [number] of products available as potential reducers of breast cancer.”
Currently, tamoxifen is the only other drug that is indicated for the reduction of breast cancer incidence in women at high risk for the disease.
Dr. Utian said the recommendation to approve raloxifene for the two new indications comes at a good time, because tamoxifen sales and use have been “disappointing” because of various side effects and particularly because of the drug's association with an increased risk of uterine cancer.
Both doctors and patients may be more accepting of raloxifene, because it is already a well-known product for osteoporosis in postmenopausal patients, and its added benefit of reducing breast cancer would make it a viable alternative to tamoxifen for these women, he said.
When the RUTH study was published, it raised some concerns about risk of death from stroke and the incidence of blood clots associated with raloxifene use (N. Engl. J. Med. 2006;355:125–37).
Marcia Stefanick, Ph.D., from Stanford (Calif.) University, wrote in an accompanying editorial: “What level of breast cancer risk would justify the use of raloxifene for the prevention of breast cancer for a given person, if one takes into account the competing risks and patient preferences? Complicating the answer is our inability to predict these risks with high accuracy on an individual basis” (N. Engl. J. Med. 2006;355:190–2).
Dr. Utian said the prevalence of both stroke and venous thromboembolism increases with age, but most of the women who would start taking tamoxifen or raloxifene for prevention would do so at a younger age, when both the prevalence and absolute risk for these adverse events would be lower. Dr. Utian disclosed that he serves as a consultant to various pharmaceutical companies, including Eli Lilly and some of its competitors.