Updated: 12/2/2021

Selective Estrogen Receptor Modulators (SERMs)

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Topic
  • Snapshot
    • A 44-year-old woman presents status-post lumpectomy and irradiation for a 2.5-cm breast mass. The breast mass is estrogen and progesterone receptor positive. Axillary nodes are negative for cancer. Tamoxifen is added to the patient's treatment regimen.
  • Tamoxifen
    • Mechanism of action
      • estrogen antagonist in breast
      • estrogen agonist in endometrium and bone
    • Clinical use
      • estrogen and progesterone receptor positive breast cancer
        • first-line treatment in premenopausal women to prevent recurrence
      • breast cancer prevention in women high risk for breast cancer
    • Toxicity
      • ↑ risk of of venous thromboembolism
      • ↑ risk of endometrial cancer
        • secondary to agonist activity
      • induces menopause
        • hot flashes
  • Raloxifene
    • Mechanism of acton
      • estrogen antagonist in breast and endometrium
      • agonist in bone
    • Clinical use
      • osteoporosis in menopausal women
      • breast cancer prevention in women high risk for breast cancer
    • Toxicity
      • ↑ risk of of venous thromboembolism
      • induces menopause
        • hot flashes
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Questions (2)

(M2.GN.15.10) A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied, and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regular outpatient follow-up appointments to monitor for any recurrence of cancer. The patient has a past medical history of asthma, obesity, and a large uterine leimyoma which was treated with a hysterectomy last year. Her last menstrual period was at the age of 47. The patient's vital signs and exam are unremarkable. Which of the following is a potential complication that could occur in this patient?

QID: 104650
1

Deep venous thrombosis

33%

(3/9)

2

Endometrial cancer

56%

(5/9)

3

Eruption of seborrheic keratoses

0%

(0/9)

4

Increased bleeding

0%

(0/9)

5

Osteoporosis

11%

(1/9)

M 8 E

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(M2.GN.15.4650) A 46-year-old female presents to her primary care physician after noting a lump in her left breast. She reports finding it two months prior to presentation and feels that it has not grown significantly in that time. She denies nipple discharge or tenderness. On exam, she is noted to have a 3-4 cm, rubbery mass in the left breast. Biopsy shows invasive ductal carcinoma that is estrogen receptor positive. Her oncologist prescribes tamoxifen. All of the following are effects of tamoxifen EXCEPT:

QID: 107048
1

Decreased risk of endometrial cancer

67%

(26/39)

2

Increased risk of deep vein thrombosis

3%

(1/39)

3

Induction of menopausal symptoms

13%

(5/39)

4

Decreased risk of osteoporosis

10%

(4/39)

5

Increased risk of ocular toxicity

5%

(2/39)

M 7 D

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