There are two types of aromatase inhibitors, irreversible steroidal activators (e.g, Exemestane) and reversible nonsteroidal Imidazole- based inhibitors (e.g, Anastrozole, Letrozole). Recent data suggest that some women who experience failure of one type of aromatase inihibitor can subsequently derive benefit from the other type. The reason for this lack of cross-resistance between the steroidal aromatase activators and nonsteroidal aromatase inhibitors offer the opportunity to increase the number of lines of hormone therapy before making the inevitable switch to more toxic chemotherapy, thus potentially improving quality of life for postmemopausal women with advanced disease.
Steroidal agents appear to have beneficial affects on lipid and bone metabolism, whereas nonsteroidal agents may have neutral or unfavorable effects. These differences may be attributed to the androgenic effects of steroidal agents. Clinical trials are currently under way to confirm these suspicions.
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