"I would argue that this is a really low NNT, and a lot of patients in your practice probably would fall into the category of qualifying for the MAP-3 study," Dr. Diamond said.
There were no serious risks associated with exemestane in MAP-3. Hot flashes and other menopausal symptoms were more common than with placebo, yet reassuringly there was no difference between the exemestane and control groups on quality of life measures.
Bone mineral density decreased over time in the exemestane group; however, patients on the aromatase inhibitor had no increased risk of fractures. Dr. Diamond advised monitoring bone density in exemestane-treated women, and if it drops significantly, consider prescribing denosumab as a subcutaneous injection once every 6 months. Denosumab is already FDA approved to increase bone mass in patients on adjuvant aromatase inhibitor therapy for breast cancer.
Dr. Diamond reported having no financial conflicts.