Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients

Naiba Nabieva, Lothar Häberle, Sara Y Brucker, Wolfgang Janni, Bernhard Volz, Christian R Loehberg, Andreas D Hartkopf, Christina-Barbara Walter, Gerold Baake, Alexander Fridman, Wolfram Malter, Rachel Wuerstlein, Nadia Harbeck, Oliver Hoffmann, Sherko Kuemmel, Bernhard Martin, Christoph Thomssen, Heiko Graf, Christopher Wolf, Michael P LuxChristian M Bayer, Claudia Rauh, Carolin C Hack, Katrin Almstedt, Paul Gass, Felix Heindl, Tobias Brodkorb, Christoph Lindner, Hans-Christian Kolberg, Petra Krabisch, Michael Weigel, Dieter Steinfeld-Birg, Andreas Kohls, Cosima Brucker, Volker Schulz, Gunnar Fischer, Volker Pelzer, Brigitte Rack, Matthias W Beckmann, Tanja Fehm, Achim Rody, Nicolai Maass, Alexander Hein, Peter A Fasching


One of the most common adverse events (AEs) occurring during treatment with aromatase inhibitors (AIs) is musculoskeletal pain. The aim of our study was to analyze the influence of preexisting muscle/limb pain and joint pain on the development of AI-induced musculoskeletal AEs. Women eligible for upfront adjuvant endocrine therapy with letrozole were included in the PreFace study, a multicenter phase IV trial. During the first treatment year, they were asked to record musculoskeletal AEs monthly by answering questions regarding pain symptoms and rating the pain intensity on a numeric rating scale from 0 (no pain) to 10 (very strong pain). Pain values were compared using nonparametric statistical tests. Overall, 1,416 patients were evaluable. The average pain value over all time points in women with preexisting muscle/limb pain was 4.3 (median 4.3); in those without preexisting pain, it was 2.0 (median 1.7). In patients without preexisting muscle/limb pain, pain levels increased relatively strongly within the first 6 months (mean increase +0.9, p < 0.00001) in comparison with those with preexisting pain (mean increase +0.3, p < 0.001), resulting in a statistically significant difference (p < 0.00001) between the two groups. The development of joint pain was similar in the two groups. Women without preexisting muscle/limb pain or joint pain have the greatest increase in pain after the start of adjuvant AI therapy. Women with preexisting pain have significantly higher pain values. The main increase in pain values takes place during the first 6 months of treatment.

Original languageEnglish
JournalInternational Journal of Cancer
Issue number8
Pages (from-to)2114-2121
Number of pages8
Publication statusPublished - 2019

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)
  • Centers: University Cancer Center Schleswig-Holstein (UCCSH)


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