A 60-year-old woman on letrozole for 3 years for stage II ER+ breast cancer complains of severe arthralgia. What is the most appropriate management step before switching therapy?
- A Switch to a different aromatase inhibitor (e.g., exemestane) ✓
- B Switch directly to tamoxifen
- C Add duloxetine and continue letrozole
- D Discontinue all endocrine therapy permanently
Correct answer: A. Switch to a different aromatase inhibitor (e.g., exemestane)
Explanation
Aromatase inhibitor-associated arthralgia (AIAA) affects up to 50% of patients and is a major cause of non-adherence. Switching to a different AI class (exemestane is a steroidal AI versus letrozole/anastrozole which are non-steroidal) often reduces arthralgias because the molecular mechanism differs. Tamoxifen is an option but its inferior outcomes in postmenopausal women make a same-class switch preferable. Duloxetine has evidence for AIAA but does not address the underlying mechanism. Permanent discontinuation sacrifices proven survival benefit.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.