Currently Approved SERMs Tamoxifen and Raloxifene

Currently Approved SERMs Tamoxifen and Raloxifene 5.4.2.1 Tamoxifen 

A 5-year course of tamoxifen treatment provides protection superior to 1-2 years of treatment. Currently, 5 years of adjuvant tamoxifen is recommended to be optimal, since extending treatment beyond 5 years provides no further improvement [137,138], There are reports of tamoxifen-stimulated tumor growth occurring during the treatment of advanced (metastatic stage IV) breast cancer [139,140], but there is currently no evidence that extending tamoxifen beyond 5 years of adjuvant therapy increases the risk of tumor recurrence. Critically important, the protective effects of tamoxifen on breast cancer recurrence and mortality are persistent long after tamoxifen therapy is stopped. A meta-analysis of 15 years of follow-up of 10,386 women shows that 5 years of adjuvant tamoxifen in ER-positive disease versus not 

4% for the total hip [221], Raloxifene has also been shown to decrease spine fractures by 40%, although there was no significant decrease in hip fractures [222]. 

Raloxifene s effects on risk factors for coronary artery disease are similar to those of estrogen, by lowering LDL cholesterol and homocysteine levels. Blood clots with raloxifene also occur at the same frequency as observed with HRT. However unlike estrogens, it does not increase triglyceride, HDL cholesterol or C-reactive protein levels [230]. Therefore, in addition to being evaluated for the prevention of 

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