51
|
Rachner TD, Coleman R, Hadji P, Hofbauer LC. Bone health during endocrine therapy for cancer. Lancet Diabetes Endocrinol 2018; 6:901-910. [PMID: 29572126 DOI: 10.1016/s2213-8587(18)30047-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/27/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
Preservation of bone health remains a long-term clinical challenge in patients with breast and prostate cancer. Osteoporosis, defined by a loss of bone mass and microarchitecture, often results in fragility fractures that are typically associated with a high socioeconomic burden. Endocrine therapy, a mainstay treatment in the management of patients with hormone-sensitive breast and prostate cancer in the adjuvant setting, commonly exerts adverse effects on the musculoskeletal system and is associated with an increased risk of osteoporosis and fractures. Adjuvant use of gonadotropin-releasing hormone analogues, which can also be used in metastatic disease, in combination with tamoxifen in premenopausal women, and aromatase inhibitors in postmenopausal women with hormone-sensitive breast cancer, causes rapid bone loss and fragility fractures. By contrast, selective oestrogen receptor modulators, such as tamoxifen, have bone-protective effects in postmenopausal women. In men with castration-sensitive prostate cancer, androgen deprivation is achieved with drugs that lower gonadotropin levels, and these drugs can be combined with androgen receptor antagonists. These therapies induce a high bone turnover with rapid bone loss that is reminiscent of the changes occurring in early menopause and result in an increased risk of fracture. In this Review, we describe how adjuvant endocrine therapies of breast and prostate cancer impair bone health and outline evidence from randomised controlled trials of strategies to reduce risk of fracture.
Collapse
Affiliation(s)
- Tilman D Rachner
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Coleman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Peyman Hadji
- Department of Bone Oncology, Krankenhaus Nordwest, Frankfurt and Philipps-University of Marburg, Marburg, Germany
| | - Lorenz C Hofbauer
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
52
|
The Importance of CYP19A1 in Estrogen Receptor-Positive Cholangiocarcinoma. Discov Oncol 2018; 9:408-419. [DOI: 10.1007/s12672-018-0349-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022] Open
|
53
|
Mitsimponas N, Klouva E, Tryfonopoulos D, Grivas A, Demiri S, Koumakis G, Gouveris P. Aromatase Inhibitor-Associated Tendinopathy and Muscle Tendon Rupture: Report of Three Cases of This Exceedingly Rare Adverse Event. Case Rep Oncol 2018; 11:557-561. [PMID: 30186139 PMCID: PMC6120376 DOI: 10.1159/000491874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
Aromatase inhibitors (AIs) are a commonly used antihormonal therapy in the treatment of breast cancer in postmenopausal women, specifically in the treatment of hormone receptor-positive breast cancer. AI-associated tendinopathy and muscle tendon rupture is exceedingly rare. Until now, only one case with AI-associated severe tendinopathy has been reported in the medical literature, and there are no recorded cases of AI-associated muscle tendon rapture. We report three cases of postmenopausal women with hormone receptor-positive breast cancer, who experienced tendinopathy or muscle tendon rupture under antihormonal treatment with letrozole. All of the three women were in the adjuvant setting, and the treatment of tendinopathy or tendon rupture consisted of AI discontinuation, initiation of corticosteroids, or surgical treatment. Diagnosis was made via MRI. Furthermore, in our cases, there were no signs of underlying systemic disease, there was no abnormal physical activity preceding the complaints, and there was no use of other drugs beside letrozole. AIs are one of the most commonly used drugs in antihormonal therapy for hormone receptor-positive breast cancer. In every case of a female patient with hormone receptor-positive breast cancer under treatment with AIs and arthralgia, an MRI should be performed in order to exclude the presence of tendinopathy or muscle tendon rupture.
Collapse
Affiliation(s)
| | - Evangelia Klouva
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
| | | | | | - Stamatina Demiri
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
| | - George Koumakis
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
| | | |
Collapse
|
54
|
Jung Y, Lee SJ, Lee J, Noh WC, Nam SJ, Park BW, Bae YT, Kang SS, Park HK, Yoon JH, Kim JR, Cho SH, Kim LS, Moon BI, Jung SH, Lim CW, Kim SY, Park HY, Song J, Lee KM, Park SH, Jeong J, Park HL, Kim SW, Kwak BS, Kang SH, Cho YU, Gwak GH, Park YL, Kim SW, Han S. Assessment of Quality of Life and Safety in Postmenopausal Breast Cancer Patients Receiving Letrozole as an Early Adjuvant Treatment. J Breast Cancer 2018; 21:182-189. [PMID: 29963114 PMCID: PMC6015975 DOI: 10.4048/jbc.2018.21.2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. Methods Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. Results All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). Conclusion QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.
Collapse
Affiliation(s)
- Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Soo Jung Lee
- Department of Surgery, Yeungnam University Hospital, Daegu, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Woo Chul Noh
- Department of Surgery, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - Byeong-Woo Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Bae
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Sung-Soo Kang
- Department of Surgery, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Heung Kyu Park
- Department of Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Jung-Han Yoon
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Je Ryong Kim
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Se Hun Cho
- Department of Surgery, Dong-A University Hospital, Busan, Korea
| | - Lee Su Kim
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Byung In Moon
- Breast Cancer Center, Ewha Womans University Hospital, Seoul, Korea
| | - Sung Hoo Jung
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Chol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Jeongyoon Song
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kwang Man Lee
- Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Sung Hwan Park
- Department of Surgery, Daegu Catholic University Hospital, Daegu, Korea
| | - Joon Jeong
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Hae Lin Park
- Department of Surgery, CHA Gangnam Medical Center, Seoul, Korea
| | - Sung Won Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
| | - Beom Seok Kwak
- Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sun Hee Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Young Up Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Geum Hee Gwak
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Yong Lae Park
- Department of Surgery, Kangbuk Samsung Hospital, Seoul, Korea
| | - Sang Wook Kim
- Department of Surgery, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Sehwan Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
55
|
Matutino A, Joy A, Brezden-Masley C, Chia S, Verma S. Hormone receptor-positive, HER2-negative metastatic breast cancer: redrawing the lines. Curr Oncol 2018; 25:S131-S141. [PMID: 29910656 PMCID: PMC6001771 DOI: 10.3747/co.25.4000] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Estrogen receptor modulators and estrogen deprivation have become standards of care for hormone receptor-positive metastatic breast cancer. However, after traditional first-line endocrine monotherapy treatment, the disease typically progresses despite the initial high rate of clinical benefit. Multiple studies have aimed at optimizing treatment strategies to improve upon clinical benefit beyond the traditional single-agent endocrine treatment. With the availability of new data and novel therapies, the clinical practice challenge becomes how best to define the optimal treatment sequence to maximize clinical benefit. In this review, we present treatment options clinically relevant to the management of hormone-positive, her2-negative metastatic breast cancer, and we propose a treatment algorithm based on the current literature.
Collapse
Affiliation(s)
- A. Matutino
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB
| | - A.A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | | | - S. Chia
- Department of Oncology, BC Cancer, Vancouver, BC
| | - S. Verma
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB
| |
Collapse
|
56
|
Longo F, Mansueto G. La Terapia Endocrina Come Terapia Causale: Ruolo Degli Inibitori Dell'aromatasi nel Carcinoma Della Mammella. TUMORI JOURNAL 2018; 89:21-8. [PMID: 14870836 DOI: 10.1177/030089160308900622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
57
|
Adjuvant aromatase inhibition: more options for patients. Lancet Oncol 2018; 19:431-432. [DOI: 10.1016/s1470-2045(18)30155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
|
58
|
Bozkaya Y, Erdem GU, Demirci NS. In case of anastrozole-related hallucinations, can switching to letrozole be a treatment option? A case report and literature review. J Oncol Pharm Pract 2018. [PMID: 29536789 DOI: 10.1177/1078155218762626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arthralgia, myalgia, paresthesia, reduced bone mineral density, vasomotor side effects including hot flashes and night sweats, genitourinary symptoms including decreased libido, vaginal dryness and dyspareunia are common side effects of aromatase inhibitors. Unlike the common side effects, the information on neurological side effects like hallucination of aromatase inhibitor was limited in literature cases. Herein, we reported a case of hallucination related to anastrozole in a patient with metastatic breast cancer. A 62-year-old female patient with breast cancer developed repetitive hallucinations on the following days of anastrozole initiation. There was no other significant finding in the differential diagnosis of hallucination. Neurological symptoms disappeared after termination of anastrozole. The patient had no neuropsychiatric complaints during letrozole treatment. We aimed to emphasize that neurological side effect like hallucination may rarely occur during the treatment of anastrozole and in case of aromatase inhibitor-related hallucinations, switching to another aromatase inhibitor (letrozole) can be a treatment option.
Collapse
Affiliation(s)
- Yakup Bozkaya
- 1 Clinic of Medical Oncology, Edirne State Hospital, Edirne, Turkey
| | - Gökmen Umut Erdem
- 2 Department of Medical Oncology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | | |
Collapse
|
59
|
Kaza V, Farmaki E, Havighorst A, Crossland J, Chatzistamou I, Kiaris H. Growth of human breast cancers in Peromyscus. Dis Model Mech 2018; 11:11/1/dmm031302. [PMID: 29343615 PMCID: PMC5818077 DOI: 10.1242/dmm.031302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Modeling breast cancer in general and hormone-sensitive breast cancer, in particular in mice, has several limitations. These are related to the inbred nature of laboratory mice, and do not allow adequate appreciation of the contribution of the host's genetic heterogeneity in tumor growth. In addition, the naturally low estrogen levels of mice makes estradiol supplementation obligatory for tumor growth. Here, we show that Peromyscus californicus, following cyclosporine-mediated immunosuppression, supports the growth of both MDA-MB-231 estrogen-independent and MCF7 estrogen receptor-positive breast cancers without exogenous estradiol supplementation. Tumor growth was inhibited by fulvestrant or letrozole, confirming that MCF7 xenografts remain hormone dependent in vivo and suggesting that P. californicus can be used as an alternative to conventional mice for the study of hormone-sensitive breast cancer. The fact that Peromyscus stocks are outbred also facilitates the study of breast cancer in genetically heterogenous populations. Summary: Outbred stocks of Peromyscus californicus (California mice), upon pharmacological immunosuppression, provide an alternative to conventional inbred mice models, and can support the growth of hormone-insensitive and hormone-sensitive human breast cancers.
Collapse
Affiliation(s)
- Vimala Kaza
- Peromyscus Genetic Stock Center, University of South Carolina, SC 29208, USA
| | - Elena Farmaki
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, SC 29208, USA
| | - Amanda Havighorst
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, SC 29208, USA
| | - Janet Crossland
- Peromyscus Genetic Stock Center, University of South Carolina, SC 29208, USA
| | - Ioulia Chatzistamou
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, SC 29208, USA
| | - Hippokratis Kiaris
- Peromyscus Genetic Stock Center, University of South Carolina, SC 29208, USA .,Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, SC 29208, USA
| |
Collapse
|
60
|
Morimoto Y, Sarumaru S, Oshima Y, Tsuruta C, Watanabe K. Joint symptoms associated with anastrozole and letrozole in patients with breast cancer: a retrospective comparative study. J Pharm Health Care Sci 2017; 3:25. [PMID: 29177067 PMCID: PMC5688801 DOI: 10.1186/s40780-017-0095-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Abstract
Background Joint symptoms are a common side effect of aromatase inhibitors. However, it is not known if the risk of these symptoms varies between the members of this drug class. The aim of this study was to compare the frequency of joint symptoms associated with anastrozole and that associated with letrozole. Methods We retrospectively reviewed patients with breast cancer who were treated with anastrozole or letrozole at Tsukiji Breast Clinic, Japan, between April 2008 and July 2014. Joint symptoms were deemed to include both joint pain and painless joint symptoms. The time to onset of joint symptoms in the anastrozole group was compared with that in the letrozole group using Kaplan–Meier curves and the log-rank test. Results Of 141 patients identified to have received aromatase inhibitors, 70 had been treated with anastrozole and 71 with letrozole. Joint symptoms occurred in 60.3% of the 141 patients (60.0% in the anastrozole group and 60.6% in the letrozole group; p = 1). Median time to appearance of joint symptoms was 583 days, with no significant difference between the anastrozole and letrozole groups (p = 0.962). There was no significant difference in time to onset of joint pain (p = 0.139); however, time to onset of painless joint symptoms was significantly shorter in the anastrozole group (p = 0.022). The sites at which joint symptoms occurred were similar in the two groups. Conclusions The results of this study indicate that there is no difference in the pattern of occurrence of joint symptoms caused by anastrozole and those caused by letrozole. Trial registration Trial registration was not required for this study because of its retrospective nature and lack of intervention.
Collapse
Affiliation(s)
- Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Shuhei Sarumaru
- Breast Clinic Tsukiji, Kaken Tsukiji Building 4F, 11-6 Akashi-cho, Chuo-ku, Tokyo, 104-0044 Japan
| | - Yuko Oshima
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Chiho Tsuruta
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543 Japan
| |
Collapse
|
61
|
Hertz DL, Speth KA, Kidwell KM, Gersch CL, Desta Z, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. Variable aromatase inhibitor plasma concentrations do not correlate with circulating estrogen concentrations in post-menopausal breast cancer patients. Breast Cancer Res Treat 2017; 165:659-668. [PMID: 28643023 PMCID: PMC5709190 DOI: 10.1007/s10549-017-4346-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE The aromatase inhibitors (AI) exemestane (EXE), letrozole (LET), and anastrozole suppress estrogen biosynthesis, and are effective treatments for estrogen receptor (ER)-positive breast cancer. Prior work suggests that anastrozole blood concentrations are associated with the magnitude of estrogen suppression. The objective of this study was to determine whether the magnitude of estrogen suppression, as determined by plasma estradiol (E2) concentrations, in EXE or LET treated patients is associated with plasma AI concentrations. METHODS Five hundred post-menopausal women with ER-positive breast cancer were enrolled in the prospective Exemestane and Letrozole Pharmacogenetic (ELPh) Study conducted by the COnsortium on BReast cancer phArmacogomics (COBRA) and randomly assigned to either drug. Estrogen concentrations were measured at baseline and after 3 months of AI treatment and drug concentrations were measured after 1 or 3 months. EXE or LET concentrations were compared with 3-month E2 concentration or the change from baseline to 3 months using several complementary statistical procedures. RESULTS Four-hundred patients with on-treatment E2 and AI concentrations were evaluable (EXE n = 200, LET n = 200). Thirty (7.6%) patients (EXE n = 13, LET n = 17) had 3-month E2 concentrations above the lower limit of quantification (LLOQ) (median: 4.75; range: 1.42-63.8 pg/mL). EXE and LET concentrations were not associated with on-treatment E2 concentrations or changes in E2 concentrations from baseline (all p > 0.05). CONCLUSIONS Steady-state plasma AI concentrations do not explain variability in E2 suppression in post-menopausal women receiving EXE or LET therapy, in contrast with prior evidence in anastrozole treated patients.
Collapse
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St. Room 3054, Ann Arbor, MI, 48109-1065, USA.
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA.
| | - Kelly A Speth
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Kelley M Kidwell
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Christina L Gersch
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
| | | | | | | | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, USA
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
| | - N Lynn Henry
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
- Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, UT, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
| |
Collapse
|
62
|
Lønning PE. Comment on "Towards a personalized approach to aromatase inhibitor therapy: a digital microfluidic platform for rapid analysis of estradiol in core-needle-biopsies" by S. Abdulwahab, A. H. C. Ng, M. D. Chamberlain, H. Ahmado, L.-A. Behan, H. Gomaa, R. F. Casper and A. R. Wheeler, Lab Chip, 2017, 17, 1594. LAB ON A CHIP 2017; 17:3186-3187. [PMID: 28816306 DOI: 10.1039/c7lc00617a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This comment on an article that appeared in Lab on a Chip (Abdulwahab et al., Lab Chip, 2017, 17, 1594) highlights the need for further validation of the proposed method.
Collapse
Affiliation(s)
- Per E Lønning
- Department of Clinical Science, Faculty of Medicine, University of Bergen and Department of Oncology, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
63
|
Overcoming aromatase inhibitor resistance in breast cancer: possible mechanisms and clinical applications. Breast Cancer 2017; 25:379-391. [PMID: 28389808 DOI: 10.1007/s12282-017-0772-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Estrogen plays crucial roles in the progression of hormone-dependent breast cancers through activation of nuclear estrogen receptor α (ER). Estrogen is produced locally from circulating inactive steroids and adrenal androgens in postmenopausal women. However, conversion by aromatase is a rate-limiting step in intratumoral estrogen production in breast cancer. Aromatase inhibitors (AIs) inhibit the growth of hormone-dependent breast cancers by blocking the conversion of adrenal androgens to estrogen and by unmasking the inhibitory effect of androgens, acting via the androgen receptor (AR). AIs are thus a standard treatment option for postmenopausal hormone-dependent breast cancer. However, although initial use of AIs provides substantial clinical benefit, some breast cancer patients relapse because of the acquisition of AI resistance. A better understanding of the mechanisms of AI resistance may contribute to the development of new therapeutic strategies and aid in the search for new therapeutic targets and agents. We have investigated AI-resistance mechanisms and established six AI-resistant cell lines. Some of them exhibit estrogen depletion-resistance properties via constitutive ER-activation or ER-independent growth signaling. We examined how breast cancer cells can adapt to estrogen depletion and androgen superabundance. Estrogen and estrogenic androgen produced independently from aromatase contributed to cell proliferation in some of these cell lines, while another showed AR-dependent cell proliferation. Based on these findings, currently proposed AI-resistance mechanisms include an aromatase-independent estrogen-producing pathway, estrogen-independent ER function, and ER-independent growth signaling. This review summarizes several hypotheses of AI-resistance mechanisms and discusses how existing or novel therapeutic agents may be applied to treat AI-resistant breast cancers.
Collapse
|
64
|
Hertz DL, Henry NL, Rae JM. Germline genetic predictors of aromatase inhibitor concentrations, estrogen suppression and drug efficacy and toxicity in breast cancer patients. Pharmacogenomics 2017; 18:481-499. [PMID: 28346074 PMCID: PMC6219438 DOI: 10.2217/pgs-2016-0205] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023] Open
Abstract
The third-generation aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, are highly effective for the treatment of estrogen receptor-positive breast cancer in postmenopausal women. AIs inhibit the aromatase (CYP19A1)-mediated production of estrogens. Most patients taking AIs achieve undetectable blood estrogen concentrations resulting in drug efficacy with tolerable side effects. However, some patients have suboptimal outcomes, which may be due, in part, to inherited germline genetic variants. This review summarizes published germline genetic associations with AI treatment outcomes including systemic AI concentrations, estrogenic response to AIs, AI treatment efficacy and AI treatment toxicities. Significant associations are highlighted with commentary about prioritization for future validation to identify pharmacogenetic predictors of AI treatment outcomes that can be used to inform personalized treatment decisions in patients with estrogen receptor-positive breast cancer.
Collapse
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84103, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-1065, USA
| |
Collapse
|
65
|
Schwartzberg LS, Yardley DA, Elias AD, Patel M, LoRusso P, Burris HA, Gucalp A, Peterson AC, Blaney ME, Steinberg JL, Gibbons JA, Traina TA. A Phase I/Ib Study of Enzalutamide Alone and in Combination with Endocrine Therapies in Women with Advanced Breast Cancer. Clin Cancer Res 2017; 23:4046-4054. [PMID: 28280092 DOI: 10.1158/1078-0432.ccr-16-2339] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/17/2016] [Accepted: 03/02/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Several lines of evidence support targeting the androgen signaling pathway in breast cancer. Enzalutamide is a potent inhibitor of androgen receptor signaling. Preclinical data in estrogen-expressing breast cancer models demonstrated activity of enzalutamide monotherapy and enhanced activity when combined with various endocrine therapies (ET). Enzalutamide is a strong cytochrome P450 3A4 (CYP3A4) inducer, and ETs are commonly metabolized by CYP3A4. The pharmacokinetic (PK) interactions, safety, and tolerability of enzalutamide monotherapy and in combination with ETs were assessed in this phase I/Ib study.Experimental Design: Enzalutamide monotherapy was assessed in dose-escalation and dose-expansion cohorts of patients with advanced breast cancer. Additional cohorts examined effects of enzalutamide on anastrozole, exemestane, and fulvestrant PK in patients with estrogen receptor-positive/progesterone receptor-positive (ER+/PgR+) breast cancer.Results: Enzalutamide monotherapy (n = 29) or in combination with ETs (n = 70) was generally well tolerated. Enzalutamide PK in women was similar to prior data on PK in men with prostate cancer. Enzalutamide decreased plasma exposure to anastrozole by approximately 90% and exemestane by approximately 50%. Enzalutamide did not significantly affect fulvestrant PK. Exposure of exemestane 50 mg/day given with enzalutamide was similar to exemestane 25 mg/day alone.Conclusions: These results support a 160 mg/day enzalutamide dose in women with breast cancer. Enzalutamide can be given in combination with fulvestrant without dose modifications. Exemestane should be doubled from 25 mg/day to 50 mg/day when given in combination with enzalutamide; this combination is being investigated in a randomized phase II study in patients with ER+/PgR+ breast cancer. Clin Cancer Res; 23(15); 4046-54. ©2017 AACR.
Collapse
Affiliation(s)
| | - Denise A Yardley
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Anthony D Elias
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Manish Patel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Florida Cancer Specialists, Sarah Cannon Research Institute, Sarasota, Florida
| | - Patricia LoRusso
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Ayca Gucalp
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Amy C Peterson
- Medivation, Inc. (Medivation, Inc., was acquired by Pfizer, Inc., in September 2016), San Francisco, California
| | - Martha E Blaney
- Medivation, Inc. (Medivation, Inc., was acquired by Pfizer, Inc., in September 2016), San Francisco, California
| | | | - Jacqueline A Gibbons
- Medivation, Inc. (Medivation, Inc., was acquired by Pfizer, Inc., in September 2016), San Francisco, California
| | - Tiffany A Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Weill Cornell Medical College, New York, New York
| |
Collapse
|
66
|
Ye H, Dudley SZ, Shaw IC. Escherichia colibiotransformation of daidzein fermentation products from soy-based foods-relevance to food oestrogenicity-based functionality. Int J Food Sci Technol 2017. [DOI: 10.1111/ijfs.13410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hui Ye
- Human Toxicology Research Group, Department of Chemistry; University of Canterbury; Christchurch New Zealand
| | - Samantha Z. Dudley
- Human Toxicology Research Group, Department of Chemistry; University of Canterbury; Christchurch New Zealand
| | - Ian C. Shaw
- Human Toxicology Research Group, Department of Chemistry; University of Canterbury; Christchurch New Zealand
| |
Collapse
|
67
|
Rodgers RJ, Reid GD, Koch J, Deans R, Ledger WL, Friedlander M, Gilchrist RB, Walters KA, Abbott JA. The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer: a systematic review. Hum Reprod 2017; 32:1033-1045. [DOI: 10.1093/humrep/dex027] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/29/2017] [Indexed: 12/29/2022] Open
|
68
|
Robarge JD, Desta Z, Nguyen AT, Li L, Hertz D, Rae JM, Hayes DF, Storniolo AM, Stearns V, Flockhart DA, Skaar TC, Henry NL. Effects of exemestane and letrozole therapy on plasma concentrations of estrogens in a randomized trial of postmenopausal women with breast cancer. Breast Cancer Res Treat 2017; 161:453-461. [PMID: 27943008 PMCID: PMC5429096 DOI: 10.1007/s10549-016-4077-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Inter-individual differences in estrogen concentrations during treatment with aromatase inhibitors (AIs) may contribute to therapeutic response and toxicity. The aim of this study was to determine plasma concentrations of estradiol (E2), estrone (E1), and estrone sulfate (E1S) in a large cohort of AI-treated breast cancer patients. METHODS In a randomized, multicenter trial of postmenopausal women with early-stage breast cancer starting treatment with letrozole (n = 241) or exemestane (n = 228), plasma estrogen concentrations at baseline and after 3 months were quantitated using a sensitive mass spectrometry-based assay. Concentrations and suppression below the lower limit of quantification (LLOQ) were compared between estrogens and between drugs. RESULTS The ranges of baseline estrogen concentrations were CONCLUSIONS Letrozole had greater suppression of plasma E1 and E1S than exemestane, though the response was highly variable among patients. Additional research is required to examine the clinical relevance of differential estrogen suppression.
Collapse
Affiliation(s)
- Jason D Robarge
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zereunesay Desta
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anne T Nguyen
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lang Li
- Center for Computational Biology and Bioinformatics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Hertz
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Anna M Storniolo
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Vered Stearns
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr #3362, Salt Lake City, UT, 84112, USA.
| |
Collapse
|
69
|
Engmann NJ, Scott CG, Jensen MR, Ma L, Brandt KR, Mahmoudzadeh AP, Malkov S, Whaley DH, Hruska CB, Wu FF, Winham SJ, Miglioretti DL, Norman AD, Heine JJ, Shepherd J, Pankratz VS, Vachon CM, Kerlikowske K. Longitudinal Changes in Volumetric Breast Density with Tamoxifen and Aromatase Inhibitors. Cancer Epidemiol Biomarkers Prev 2017; 26:930-937. [PMID: 28148596 DOI: 10.1158/1055-9965.epi-16-0882] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 01/13/2023] Open
Abstract
Background: Reductions in breast density with tamoxifen and aromatase inhibitors may be an intermediate marker of treatment response. We compare changes in volumetric breast density among breast cancer cases using tamoxifen or aromatase inhibitors (AI) to untreated women without breast cancer.Methods: Breast cancer cases with a digital mammogram prior to diagnosis and after initiation of tamoxifen (n = 366) or AI (n = 403) and a sample of controls (n = 2170) were identified from the Mayo Clinic Mammography Practice and San Francisco Mammography Registry. Volumetric percent density (VPD) and dense breast volume (DV) were measured using Volpara (Matakina Technology) and Quantra (Hologic) software. Linear regression estimated the effect of treatment on annualized changes in density.Results: Premenopausal women using tamoxifen experienced annualized declines in VPD of 1.17% to 1.70% compared with 0.30% to 0.56% for controls and declines in DV of 7.43 to 15.13 cm3 compared with 0.28 to 0.63 cm3 in controls, for Volpara and Quantra, respectively. The greatest reductions were observed among women with ≥10% baseline density. Postmenopausal AI users had greater declines in VPD than controls (Volpara P = 0.02; Quantra P = 0.03), and reductions were greatest among women with ≥10% baseline density. Declines in VPD among postmenopausal women using tamoxifen were only statistically greater than controls when measured with Quantra.Conclusions: Automated software can detect volumetric breast density changes among women on tamoxifen and AI.Impact: If declines in volumetric density predict breast cancer outcomes, these measures may be used as interim prognostic indicators. Cancer Epidemiol Biomarkers Prev; 26(6); 930-7. ©2017 AACR.
Collapse
Affiliation(s)
| | | | | | - Lin Ma
- University of California, San Francisco, San Francisco, California
| | | | | | - Serghei Malkov
- University of California, San Francisco, San Francisco, California
| | | | | | | | | | - Diana L Miglioretti
- University of California, Davis, Davis, California.,Group Health Research Institute, Seattle, Washington
| | | | | | - John Shepherd
- University of California, San Francisco, San Francisco, California
| | - V Shane Pankratz
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | | |
Collapse
|
70
|
Bošković L, Gašparić M, Petković M, Gugić D, Lovasić IB, Soldić Ž, Miše BP, Dabelić N, Vazdar L, Vrdoljak E. Bone health and adherence to vitamin D and calcium therapy in early breast cancer patients on endocrine therapy with aromatase inhibitors. Breast 2017; 31:16-19. [DOI: 10.1016/j.breast.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
|
71
|
Smith I, Yardley D, Burris H, De Boer R, Amadori D, McIntyre K, Ejlertsen B, Gnant M, Jonat W, Pritchard KI, Dowsett M, Hart L, Poggio S, Comarella L, Salomon H, Wamil B, O'Shaughnessy J. Comparative Efficacy and Safety of Adjuvant Letrozole Versus Anastrozole in Postmenopausal Patients With Hormone Receptor-Positive, Node-Positive Early Breast Cancer: Final Results of the Randomized Phase III Femara Versus Anastrozole Clinical Evaluation (FACE) Trial. J Clin Oncol 2017; 35:1041-1048. [PMID: 28113032 DOI: 10.1200/jco.2016.69.2871] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The Letrozole (Femara) Versus Anastrozole Clinical Evaluation (FACE) study compared the efficacy and safety of adjuvant letrozole versus anastrozole in postmenopausal patients with hormone receptor (HR) -positive and node-positive early breast cancer (eBC). Methods Postmenopausal women with HR-positive and node-positive eBC were randomly assigned to receive adjuvant therapy with either letrozole (2.5 mg) or anastrozole (1 mg) once per day for 5 years or until recurrence of disease. Patients were stratified on the basis of the number of lymph nodes and human epidermal growth factor receptor 2 status. The primary end point was 5-year disease-free survival (DFS), and the key secondary end points were overall survival and safety. Results A total of 4,136 patients were randomly assigned to receive either letrozole (n = 2,061) or anastrozole (n = 2,075). The final analysis was done at 709 DFS events (letrozole, 341 [16.5%]; anastrozole, 368 [17.7%]). The 5-year estimated DFS rate was 84.9% for letrozole versus 82.9% for anastrozole arm (hazard ratio, 0.93; 95% CI, 0.80 to 1.07; P = .3150). Exploratory analysis showed similar DFS with letrozole and anastrozole in all evaluated subgroups. The 5-year estimated overall survival rate was 89.9% for letrozole versus 89.2% for anastrozole arm (hazard ratio, 0.98; 95% CI, 0.82 to 1.17; P = .7916). Most common grade 3 to 4 adverse events (> 5% of patients) reported for letrozole versus anastrozole were arthralgia (3.9% v 3.3%, and 48.2% v 47.9% for all adverse events), hypertension (1.2% v 1.0%), hot flushes (0.8% v 0.4%), myalgia (0.8% v 0.7%), dyspnea (0.8% v 0.5%), and depression (0.8% v 0.6%). Conclusion Letrozole did not demonstrate significantly superior efficacy or safety compared with anastrozole in postmenopausal patients with HR-positive, node-positive eBC.
Collapse
Affiliation(s)
- Ian Smith
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Denise Yardley
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Howard Burris
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Richard De Boer
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Dino Amadori
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Kristi McIntyre
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Bent Ejlertsen
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Michael Gnant
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Walter Jonat
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Kathleen I Pritchard
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Mitch Dowsett
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Lowell Hart
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Susan Poggio
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Lisa Comarella
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Herve Salomon
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Barbara Wamil
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Joyce O'Shaughnessy
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| |
Collapse
|
72
|
Flågeng MH, Larionov A, Geisler J, Knappskog S, Prestvik WS, Bjørkøy G, Lilleng PK, Dixon JM, Miller WR, Lønning PE, Mellgren G. Treatment with aromatase inhibitors stimulates the expression of epidermal growth factor receptor-1 and neuregulin 1 in ER positive/HER-2/neu non-amplified primary breast cancers. J Steroid Biochem Mol Biol 2017; 165:228-235. [PMID: 27343990 DOI: 10.1016/j.jsbmb.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
While estrogens have been shown to modulate EGFR/HER-1 and HER-2/neu expression in experimental systems, the effects of estrogen deprivation on expression levels of the HER-receptors and the neuregulin (NRG)1 ligand in breast cancers remain unknown. Here, we measured EGFR/HER-1-4 and NRG1 mRNA in ER positive tumors from 85 postmenopausal breast cancer patients before and after two weeks (n=64) and three months (n=85) of primary treatment with an aromatase inhibitor (AI). In tumors lacking HER-2/neu amplification, quantitative real-time PCR analyses revealed EGFR/HER-1 and NRG1 to vary significantly between the three time points (before therapy, after 2 weeks and after 3 months on treatment; P≤0.001 for both). Pair-wise comparison revealed a significant increase in EGFR/HER-1 already during the first two weeks of treatment (P=0.049) with a further increase for both EGFR/HER-1 and NRG1 after 3 months on treatment (P≤0.001 and P=0.001 for both comparing values at 3 months to values at baseline and 2 weeks respectively). No difference between tumors responding versus non-responders was recorded. Further, no significant change in any parameter was observed among HER-2/neu amplified tumors. Analyzing components of the HER-2/neu PI3K/Akt downstream pathway, the PIK3CA H1047R mutation was associated with treatment response (P=0.035); however no association between either AKT phosphorylation status or PIK3CA gene mutations and EGFR/HER-1 or NRG1 expression levels were observed. Our results indicate primary AI treatment to modulate expression of HER-family members and the growth factor NRG1 in HER-2/neu non-amplified breast cancers in vivo. Potential implications to long term sensitivity warrants further investigations.
Collapse
Affiliation(s)
- Marianne Hauglid Flågeng
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Hormone Laboratory, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Alexey Larionov
- University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom; Department of Medical Genetics, Cambridge University, Cambridge, United Kingdom.
| | - Jürgen Geisler
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway.
| | - Stian Knappskog
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Oncology, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Wenche S Prestvik
- Department of Technology, University College of Sør-Trøndelag, 7491 Trondheim, Norway.
| | - Geir Bjørkøy
- Department of Technology, University College of Sør-Trøndelag, 7491 Trondheim, Norway.
| | - Peer Kåre Lilleng
- The Gades Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; Department of Pathology, Haukeland University Hospital, 5021 Bergen, Norway.
| | - J Michael Dixon
- University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
| | - William R Miller
- University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
| | - Per Eystein Lønning
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Oncology, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Gunnar Mellgren
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Hormone Laboratory, Haukeland University Hospital, 5021 Bergen, Norway.
| |
Collapse
|
73
|
Yao S, Zhang Y, Tang L, Roh JM, Laurent CA, Hong CC, Hahn T, Lo JC, Ambrosone CB, Kushi LH, Kwan ML. Bone remodeling and regulating biomarkers in women at the time of breast cancer diagnosis. Breast Cancer Res Treat 2016; 161:501-513. [PMID: 27915435 DOI: 10.1007/s10549-016-4068-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/25/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE The majority of breast cancer patients receive endocrine therapy, including aromatase inhibitors known to cause increased bone resorption. Bone-related biomarkers at the time of breast cancer diagnosis may predict future risk of osteoporosis and fracture after endocrine therapy. METHODS In a large population of 2,401 female breast cancer patients who later underwent endocrine therapy, we measured two bone remodeling biomarkers, TRAP5b and BAP, and two bone regulating biomarkers, RANKL and OPG, in serum samples collected at the time of breast cancer diagnosis. We analyzed these biomarkers and their ratios with patients' demographic, lifestyle, clinical tumor characteristics, as well as bone health history. RESULTS The presence of bone metastases, prior bisphosphonate (BP) treatment, and blood collection after chemotherapy had a significant impact on biomarker levels. After excluding these cases and controlling for blood collection time, several factors, including age, race/ethnicity, body mass index, physical activity, alcohol consumption, smoking, and hormonal replacement therapy, were significantly associated with bone biomarkers, while vitamin D or calcium supplements and tumor characteristics were not. When prior BP users were included in, recent history of osteoporosis and fracture was also associated. CONCLUSIONS Our findings support further investigation of these biomarkers with bone health outcomes after endocrine therapy initiation in women with breast cancer.
Collapse
Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA.
| | - Yali Zhang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA.,Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
74
|
Phase 1b study of orteronel in postmenopausal women with hormone-receptor positive (HR+) metastatic breast cancer. Invest New Drugs 2016; 35:87-94. [PMID: 27826831 DOI: 10.1007/s10637-016-0403-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Introduction Suppressing both androgens and estrogens may circumvent hormone receptor resistance in breast cancer by reducing androgen receptor stimulation. Selective inhibition of the 17, 20-lyase enzyme by orteronel leads to decreased androgen production in men and would be anticipated to reduce estrogen and androgen production in women. Thus, we conducted a phase 1b study of orteronel in postmenopausal women with hormone-receptor positive (HR+) metastatic breast cancer. Methods The primary objective was to identify the recommended phase 2 dose (R2PD) of orteronel in women; escalation was via standard 3 + 3 design. The initial dose was 300 mg BID and escalated to 400 mg BID. Cycle length was 28 days. Enrolled patients had HR+ metastatic breast cancer and were evaluated every 8 weeks for disease progression. Results Eight heavily pre-treated women enrolled [median age: 57 yo (range 47-73)]. Four received 300 mg BID at dose level 1; 4 received 400 mg BID at dose level 2. No dose limiting toxicities (DLTs) were observed. Adverse events (AE) at least possibly related to orteronel included grade 1-2 nausea (n = 4) and bone pain (n = 3), and grade 1 hypokalemia, hot flashes, myalgia and AST elevation (n = 2). The only grade 3 AE was hypertension (n = 2) with 8 patients receiving 34 cycles of treatment. No objective responses were seen; clinical benefit was seen in 2 patients with stable disease for more than 6 months. Serum estrogens and testosterone were suppressed from baseline on both doses of orteronel. Conclusions Orteronel 400 mg BID is well tolerated in postmenopausal women, and significantly suppresses serum estrogens and testosterone. Clinical benefit was seen among heavily pretreated postmenopausal women with HR+ metastatic breast cancer.
Collapse
|
75
|
Torrisi R, Rota S, Losurdo A, Zuradelli M, Masci G, Santoro A. Aromatase inhibitors in premenopause: Great expectations fulfilled? Crit Rev Oncol Hematol 2016; 107:82-89. [DOI: 10.1016/j.critrevonc.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/14/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022] Open
|
76
|
María RS, Marta PM, Sonia S, Natalia GG, Tamara M, Ignasi T, Maria MG, Jaime RM, Adolfo DP, Joan A, Xavier N. TBS and BMD at the end of AI-therapy: A prospective study of the B-ABLE cohort. Bone 2016; 92:1-8. [PMID: 27519968 DOI: 10.1016/j.bone.2016.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Patients with breast cancer under aromatase inhibitor (AI) treatment often develop osteoporosis and their average bone loss rate is twice that of natural reduction during menopause, increasing fracture risk. As the current diagnostic technique based on bone mineral density (BMD) provides no information on bone quality, the Trabecular Bone Score (TBS) has been proposed to reflect bone microarchitecture status. The present study was designed to assess prospective changes in TBS and lumbar spine (LS) BMD in postmenopausal women with breast cancer at completion of AI treatment. METHODS B-ABLE is a prospective cohort of 735 women with breast cancer treated with AIs according to American Society of Clinical Oncology recommendations: 5years of AI starting within 6weeks post-surgery or 1month after the last cycle of chemotherapy (5y-AI group), or switching to an AI to complete 5-year therapy after 2-3years of tamoxifen (pTMX-AI group). Patients with osteoporosis were treated with oral bisphosphonates (BP). TBS and LS-BMD changes at completion of AI therapy were evaluated by Student t-test for paired samples. Pearson correlation coefficients were computed for correlations between LS-BMD and TBS. RESULTS AI treatment was completed by 277 women. Of these, 70 (25.3%) were allocated to BP therapy. The non-BP-treated patients (74.7%) showed significant decreases in TBS (-2.94% in pTMX-AI and -2.93% in 5y-AI groups) and in LS-BMD (-4.14% in pTMX-AI and -2.28% in 5y-AI groups) at the end of AI treatment. In BP-treated patients, TBS remained stable at the end of AI treatment, whereas LS-BMD showed significant increases (+2.30% in pTMX-AI and +5.33% in 5y-AI groups). Moderate associations between TBS and LS-BMD values at baseline and at the end of AI treatment (r=0.4; P<0.001) were observed. At the end of treatment, changes in spine BMD and TBS were weakly correlated (r=0.1, P<0.01). CONCLUSIONS AI therapy induces significant decreases in TBS, comparable to BMD loss. BP-treated patients maintained TBS values, whereas BMD increased. AI treatment leads to deterioration of bone microarchitecture, which seems to be attenuated by BP therapy.
Collapse
Affiliation(s)
- Rodríguez-Sanz María
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Pineda-Moncusí Marta
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain
| | - Servitja Sonia
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Garcia-Giralt Natalia
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain.
| | - Martos Tamara
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tusquets Ignasi
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martínez-García Maria
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodriguez-Morera Jaime
- Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diez-Perez Adolfo
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albanell Joan
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), Medical Oncology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nogués Xavier
- IMIM (Hospital del Mar Research Institute), Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Barcelona, Spain; Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
77
|
Briest S, Stearns V. Advances in the Adjuvant and Neoadjuvant Treatment of Breast Cancer. WOMENS HEALTH 2016; 3:325-39. [DOI: 10.2217/17455057.3.3.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Several advances in the adjuvant systemic therapy of primary breast cancer have occurred in the last decade and contributed to a decline in disease-related mortality. These include the introduction of aromatase inhibitors, new chemotherapy agents, and the novel antibody trastuzumab. New supportive treatments, such as growth factors, have contributed to the optimization of chemotherapy dose and schedule, and have improved the efficacy and safety of the treatment. In this review we will outline some of the recent advances in the adjuvant and neoadjuvant treatment of breast cancer. We will also discuss ongoing and proposed clinical trials.
Collapse
Affiliation(s)
- Susanne Briest
- University of Leipzig, Department of Gynecology and Obstetrics, Leipzig Germany
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 186, Baltimore, MD 21231-1000, USA, Tel.: +1 410 502 3472; Fax: +1 410 614 9421
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB I, Room 1M-53 Baltimore, MD 21231-1000, USA, Tel.: +1 443 287 6489; Fax: +1 410 955 0125
| |
Collapse
|
78
|
Lipton A, Gnant M, Aapro M. Managing Aromatase Inhibitor-Associated Bone Loss in Breast Cancer. WOMENS HEALTH 2016; 3:441-8. [DOI: 10.2217/17455057.3.4.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although the incidence of breast cancer has increased, there is a concurrent decrease in the death rate, and the outlook for women with early-stage breast cancer remains positive. The current 5-year survival rate of women diagnosed with breast cancer is nearly 90%, due, in part, to the use of effective adjuvant therapies that often include aromatase inhibitors. However, long-term treatment with these therapies is known to have adverse effects on bone metabolism, leading to bone loss. Bone loss during adjuvant endocrine therapy may be higher than that observed during menopause and may require more potent therapy. Although there are approved treatments for osteolytic bone lesions from bone metastases, there is no approved therapy for bone loss associated with adjuvant cancer therapy. Bisphosphonates have demonstrated promising results in this setting, and zoledronic acid is currently under consideration by the US FDA and Europe (EMEA) for the treatment of aromatase inhibitor-associated bone loss.
Collapse
Affiliation(s)
- Allan Lipton
- Pennsylvania State University, Milton S Hershey Medical Center, 500 University Drive, Hershey Pennsylvania, PA 17033, USA, Tel.: +1 717 531 5960; Fax: +1 717 531 5076
| | - Michael Gnant
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria, Tel.: +43 01 40400 5646; Fax: +43 01 40400 6807
| | - Matti Aapro
- Doyen IMO Clinique de Genolier, 1 route du Muids, CH 1272, Genolier, Switzerland, Tel.: +41 22 366 9106; Fax: +41 22 366 9131
| |
Collapse
|
79
|
Kümler I, Knoop AS, Jessing CAR, Ejlertsen B, Nielsen DL. Review of hormone-based treatments in postmenopausal patients with advanced breast cancer focusing on aromatase inhibitors and fulvestrant. ESMO Open 2016; 1:e000062. [PMID: 27843622 PMCID: PMC5070302 DOI: 10.1136/esmoopen-2016-000062] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/14/2022] Open
Abstract
Background Endocrine therapy constitutes a central modality in the treatment of oestrogen receptor (ER)-positive advanced breast cancer. Purpose To evaluate the evidence for endocrine treatment in postmenopausal patients with advanced breast cancer focusing on the aromatase inhibitors, letrozole, anastrozole, exemestane and fulvestrant. Methods A review was carried out using PubMed. Randomised phase II and III trials reporting on ≥100 patients were included. Results 35 trials met the inclusion criteria. If not used in the adjuvant setting, a non-steroid aromatase inhibitor was the optimal first-line option. In general, the efficacy of the different aromatase inhibitors and fulvestrant was similar in tamoxifen-refractory patients. A randomised phase II trial of palbociclib plus letrozole versus letrozole alone showed significantly increased progression-free survival (PFS) when compared with endocrine therapy alone in the first-line setting (20.2 vs 10.2 months). Furthermore, the addition of everolimus to exemestane in the Breast Cancer Trials of OraL EveROlimus-2 (BOLERO-2) study resulted in an extension of median PFS by 4.5 months after recurrence/progression on a non-steroid aromatase inhibitor. However, overall survival was not significantly increased. Conclusion Conventional treatment with an aromatase inhibitor or fulvestrant may be an adequate treatment option for most patients with hormone receptor-positive advanced breast cancer. Mammalian target of rapamycin (mTOR) inhibition and cyclin-dependent kinase 4/6 (CDK4/6) inhibition might represent substantial advances for selected patients in some specific settings. However, there is an urgent need for prospective biomarker-driven trials to identify patients for whom these treatments are cost-effective.
Collapse
Affiliation(s)
- Iben Kümler
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Ann S Knoop
- Department of Oncology , Finsen Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Christina A R Jessing
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Bent Ejlertsen
- Department of Oncology , Finsen Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Dorte L Nielsen
- Department of Oncology , Herlev Hospital, University of Copenhagen , Herlev , Denmark
| |
Collapse
|
80
|
Hertz DL, Barlow WE, Kidwell KM, Albain KS, Vandenberg TA, Dakhil SR, Tirumali NR, Livingston RB, Gralow J, Hayes DF, Hortobagyi GN, Mehta RS, Rae JM. Fulvestrant decreases anastrozole drug concentrations when taken concurrently by patients with metastatic breast cancer treated on SWOG study S0226. Br J Clin Pharmacol 2016; 81:1134-41. [PMID: 26859101 PMCID: PMC4876171 DOI: 10.1111/bcp.12904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/25/2016] [Accepted: 02/03/2016] [Indexed: 11/29/2022] Open
Abstract
AIMS In the SWOG S0226 trial the combination of anastrozole plus fulvestrant (n = 349) was superior to anastrozole alone (n = 345) in hormone receptor (HR)-positive metastatic breast cancer. Here we report a pharmacokinetic subset analysis investigating a possible drug interaction between anastrozole and fulvestrant. METHODS Post-menopausal patients with HR-positive metastatic breast cancer were randomized to anastrozole with or without concurrent fulvestrant. Blood samples were collected at 2, 4, 6 and 8 months, just prior to receiving the next dose of anastrozole and fulvestrant. Drug concentrations were measured via LC/MS-MS. Anastrozole concentration was compared in patients on anastrozole alone vs. patients on concomitant fulvestrant. Comparisons were made at each time point using parametric tests and over time using a linear mixed effects model. RESULTS A total of 483 anastrozole concentration measurements were included, 224 samples from 64 patients on the anastrozole alone arm and 259 from 73 patients on the combination arm. The mean anastrozole concentration in the combination arm was significantly lower than that in the anastrozole alone arm at each sample collection time (all P < 0.01) and in the mixed effects model (an estimated difference of 9.85 ng ml(-1) (95% CI 5.69, 14.00 ng ml(-1) ), P < 0.001). CONCLUSION A significant pharmacokinetic drug interaction was detected, in which the addition of fulvestrant to anastrozole treatment decreased the trough anastrozole concentration. Further research is needed to verify whether this interaction affects treatment efficacy and to determine the pharmacological mechanism by which this interaction occurs.
Collapse
Affiliation(s)
- Daniel L Hertz
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | - Kelley M Kidwell
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Ted A Vandenberg
- London Health Sciences Center/National Cancer Institute of Canada Clinical, Trials Group, London, ON, Canada
| | | | | | | | - Julie Gralow
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Daniel F Hayes
- Division of Hematology/Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | | | - Rita S Mehta
- University of California Irvine Medical Center, Chao Family Comprehensive, Cancer Center, Orange, CA, USA
| | - James M Rae
- Division of Hematology/Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| |
Collapse
|
81
|
Robarge JD, Duarte DB, Shariati B, Wang R, Flockhart DA, Vasko MR. Aromatase inhibitors augment nociceptive behaviors in rats and enhance the excitability of sensory neurons. Exp Neurol 2016; 281:53-65. [PMID: 27072527 DOI: 10.1016/j.expneurol.2016.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 12/22/2022]
Abstract
Although aromatase inhibitors (AIs) are commonly used therapies for breast cancer, their use is limited because they produce arthralgia in a large number of patients. To determine whether AIs produce hypersensitivity in animal models of pain, we examined the effects of the AI, letrozole, on mechanical, thermal, and chemical sensitivity in rats. In ovariectomized (OVX) rats, administering a single dose of 1 or 5mg/kg letrozole significantly reduced mechanical paw withdrawal thresholds, without altering thermal sensitivity. Repeated injection of 5mg/kg letrozole in male rats produced mechanical, but not thermal, hypersensitivity that extinguished when drug dosing was stopped. A single dose of 5mg/kg letrozole or daily dosing of letrozole or exemestane in male rats also augmented flinching behavior induced by intraplantar injection of 1000nmol of adenosine 5'-triphosphate (ATP). To determine whether sensitization of sensory neurons contributed to AI-induced hypersensitivity, we evaluated the excitability of neurons isolated from dorsal root ganglia of male rats chronically treated with letrozole. Both small and medium-diameter sensory neurons isolated from letrozole-treated rats were more excitable, as reflected by increased action potential firing in response to a ramp of depolarizing current, a lower resting membrane potential, and a lower rheobase. However, systemic letrozole treatment did not augment the stimulus-evoked release of the neuropeptide calcitonin gene-related peptide (CGRP) from spinal cord slices, suggesting that the enhanced nociceptive responses were not secondary to an increase in peptide release from sensory endings in the spinal cord. These results provide the first evidence that AIs modulate the excitability of sensory neurons, which may be a primary mechanism for the effect of these drugs to augment pain behaviors in rats.
Collapse
Affiliation(s)
- Jason D Robarge
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Djane B Duarte
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Laboratório de Farmacologia Molecular, Faculdade de Ciências da Saúde, Universidade de Brasília, Brazil.
| | - Behzad Shariati
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Ruizhong Wang
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - David A Flockhart
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Michael R Vasko
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
| |
Collapse
|
82
|
Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo - Meta-analyses on efficacy and adverse events based on randomized clinical trials. Breast 2016; 26:106-14. [PMID: 27017249 DOI: 10.1016/j.breast.2016.01.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/17/2015] [Accepted: 01/21/2016] [Indexed: 12/25/2022] Open
Abstract
Tamoxifen (TAM) and aromatase inhibitors (AI) are adjuvant therapy options for postmenopausal women with estrogen receptor positive (ER+) breast cancer. This systematic review of seven randomized controlled studies comparing TAM and AI, and one study comparing extended therapy with an AI with placebo after about 5 years of tamoxifen, aims to assess long-term clinical efficacy and adverse events. The literature review was performed according to the principles of the Cochrane Collaboration. The search included common databases up to 2013-01-14. Studies of high or moderate quality were used for grading of evidence. Revman™ software was utilized for meta-analyses of published data. Disease free survival (DFS) and overall survival (OS) were improved with AI monotherapy compared to TAM with high and moderate quality of evidence respectively. Sequenced therapy with AI → TAM (or vice versa) improved DFS compared with TAM with moderate quality of evidence, but did not improve OS (low quality of evidence). However, if only studies on sequenced AI therapy with randomization before endocrine therapy were considered, no improvement of DFS could be found. Fractures are more frequently associated with AI whereas the risk of endometrial cancer and venous thromboembolism are higher with TAM. For cardiovascular events no difference was found between AI (mono- or sequenced therapy) and TAM, whereas sequenced therapy compared with AI had lower risk of cardiovascular events (moderate level of evidence). AIs are superior to TAM as adjuvant hormonal therapy for postmenopausal ER-positive breast cancer. TAM can be considered for individual patients due to the different toxicity profile compared with AI. Cardiovascular events related to AI treatment deserve further attention.
Collapse
|
83
|
López AM, Pruthi S, Boughey JC, Perloff M, Hsu CH, Lang JE, Ley M, Frank D, Taverna JA, Chow HHS. Double-Blind, Randomized Trial of Alternative Letrozole Dosing Regimens in Postmenopausal Women with Increased Breast Cancer Risk. Cancer Prev Res (Phila) 2016; 9:142-8. [PMID: 26667449 PMCID: PMC4740217 DOI: 10.1158/1940-6207.capr-15-0322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023]
Abstract
Aromatase inhibitors (AI) profoundly suppress estrogen levels in postmenopausal women and are effective in breast cancer prevention among high-risk postmenopausal women. Unfortunately, AI treatment is associated with undesirable side effects that limit patient acceptance for primary prevention of breast cancer. A double-blind, randomized trial was conducted to determine whether low and intermittent doses of letrozole can achieve effective estrogen suppression with a more favorable side-effect profile. Overall, 112 postmenopausal women at increased risk for breast cancer were randomized to receive letrozole at 2.5 mg once daily (QD, standard dose arm), 2.5 mg every Monday, Wednesday, and Friday (Q-MWF), 1.0 mg Q-MWF, or 0.25 mg Q-MWF for 24 weeks. Primary endpoint was suppression in serum estradiol levels at the end of letrozole intervention. Secondary endpoints included changes in serum estrone, testosterone, C-telopeptide (marker of bone resorption), lipid profile, and quality-of-life measures (QoL) following treatment. Significant estrogen suppression was observed in all dose arms with an average of 75% to 78% and 86% to 93% reduction in serum estradiol and estrone levels, respectively. There were no differences among dose arms with respect to changes in C-telopeptide levels, lipid profile, adverse events (AE), or QoL measures. We conclude that low and intermittent doses of letrozole are not inferior to standard dose in estrogen suppression and resulted in a similar side-effect profile compared with standard dose. Further studies are needed to determine the feasibility of selecting an effective AI dosing schedule with better tolerability.
Collapse
Affiliation(s)
- Ana Maria López
- Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Sandhya Pruthi
- Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Marjorie Perloff
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Chiu-Hsieh Hsu
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Julie E Lang
- Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Michele Ley
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Denise Frank
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | | | - H-H Sherry Chow
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona.
| |
Collapse
|
84
|
Bellet M, Gray KP, Francis PA, Láng I, Ciruelos E, Lluch A, Climent MA, Catalán G, Avella A, Bohn U, González-Martin A, Ferrer R, Catalán R, Azaro A, Rajasekaran A, Morales J, Vázquez J, Fleming GF, Price KN, Regan MM. Twelve-Month Estrogen Levels in Premenopausal Women With Hormone Receptor-Positive Breast Cancer Receiving Adjuvant Triptorelin Plus Exemestane or Tamoxifen in the Suppression of Ovarian Function Trial (SOFT): The SOFT-EST Substudy. J Clin Oncol 2016; 34:1584-93. [PMID: 26729437 DOI: 10.1200/jco.2015.61.2259] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To describe estradiol (E2), estrone (E1), and estrone sulfate (E1S) levels during the first year of monthly triptorelin plus exemestane or tamoxifen and to assess possible suboptimal suppression while receiving exemestane plus triptorelin. PATIENTS AND METHODS Premenopausal patients with early breast cancer on the Suppression of Ovarian Function Trial who selected triptorelin as the ovarian suppression method and were randomly assigned to exemestane plus triptorelin or tamoxifen plus triptorelin were enrolled until the target population of 120 patients was reached. Blood sampling time points were 0, 3, 6, 12, 18, 24, 36, and 48 months. Serum estrogens were measured with a highly sensitive and specific assay. This preplanned 12-month analysis evaluated E2, E1, E1S, follicle-stimulating hormone, and luteinizing hormone levels in all patients and the proportion of patients with E2 levels greater than 2.72 pg/mL at any time point during treatment with exemestane plus triptorelin. RESULTS One hundred sixteen patients (exemestane, n = 86; tamoxifen, n = 30; median age, 44 years; median E2, 51 pg/mL; 55% prior chemotherapy) started triptorelin and had one or more samples drawn. With exemestane plus triptorelin, median reductions from baseline E2, E1, and E1S levels were consistently ≥ 95%, resulting in significantly lower levels than with tamoxifen plus triptorelin at all time points. Among patients on exemestane plus triptorelin, 25%, 24%, and 17% had an E2 level greater than 2.72 pg/mL at 3, 6, and 12 months, respectively. Baseline factors related to on-treatment E2 level greater than 2.72 pg/mL were no prior chemotherapy (P = .06), higher body mass index (P = .05), and lower follicle-stimulating hormone and luteinizing hormone (each P < .01). CONCLUSION During the first year, most patients on exemestane plus triptorelin had E2 levels below the defined threshold of 2.72 pg/mL, consistent with levels reported in postmenopausal patients on aromatase inhibitors, but at each time point, at least 17% of patients had levels greater than the threshold.
Collapse
Affiliation(s)
- Meritxell Bellet
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary.
| | - Kathryn P Gray
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Prudence A Francis
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - István Láng
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Eva Ciruelos
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Ana Lluch
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Miguel Angel Climent
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Gustavo Catalán
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Antoni Avella
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Uriel Bohn
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Antonio González-Martin
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Roser Ferrer
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Roberto Catalán
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Analía Azaro
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Agnita Rajasekaran
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Josefa Morales
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Josep Vázquez
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Gini F Fleming
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Karen N Price
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Meredith M Regan
- Meritxell Bellet and Analía Azaro, Vall d'Hebron Institute of Oncology; Meritxell Bellet, Roser Ferrer, Roberto Catalán, and Analía Azaro, Vall d'Hebron University Hospital; Meritxell Bellet, Universitat Autònoma de Barcelona; Meritxell Bellet, Eva Ciruelos, Ana Lluch, Miguel Angel Climent, Gustavo Catalán, Antoni Avella, Uriel Bohn, Antonio González-Martin, Josefa Morales, and Josep Vázquez, SOLTI Group, Barcelona; Eva Ciruelos, University Hospital 12 de Octubre; Antonio González-Martin, MD Anderson Cancer Center Madrid, Madrid; Ana Lluch, Hospital Clinico Universitario de Valencia/Incliva Biomedical Research Institute; Miguel Angel Climent, Instituto Valenciano de Oncologia, Valencia; Gustavo Catalán, Hospital Son Llàtzer; Antoni Avella, Hospital Universitario Son Espases, Palma de Mallorca; Uriel Bohn, Hospital Dr Negrín de Gran Canaria, Canary Islands, Spain; Kathryn P. Gray and Meredith M. Regan, Dana-Farber Cancer Institute; Kathryn P. Gray, Harvard T.H. Chan School of Public Health; Kathryn P. Gray, Karen N. Price, and Meredith M. Regan, International Breast Cancer Study Group Statistical Center; Karen N. Price, Frontier Science and Technology Research Foundation; Meredith M. Regan, Harvard Medical School, Boston, MA; Agnita Rajasekaran, inVentiv Health Clinical Laboratory, Princeton, NJ; Gini F. Fleming, The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL; Prudence A. Francis, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, and International Breast Cancer Study Group, Melbourne, Victoria, Australia; and István Láng, National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| |
Collapse
|
85
|
Behan LA, Amir E, Casper RF. Aromatase inhibitors for prevention of breast cancer in postmenopausal women: a narrative review. Menopause 2015; 22:342-50. [PMID: 25692874 DOI: 10.1097/gme.0000000000000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The increasing incidence of breast cancer (BC) worldwide has resulted in widespread interest in primary prevention therapies. A number of large randomized trials have shown that selective estrogen receptor modulators can reduce the relative risk for BC by 30% to 40% in high-risk women. In early-stage BC, aromatase inhibitors (AIs) showed a 35% relative reduction in the risk of contralateral BCs compared with tamoxifen. In this narrative review, we discuss the role of AIs in the primary prevention of BC and novel research on combination hormone therapy-medical therapy for the primary prevention of BC. METHODS Using PubMed/Medline, we comprehensively searched for studies of BC primary prevention using AIs, including studies of novel methods of prevention using combination hormone therapy-BC prevention. RESULTS Two large multicenter, prospective, randomized, placebo-controlled trials have evaluated AIs--anastrozole (International Breast Cancer Intervention Study II) and exemestane (Mammary Prevention 3)--for BC risk reduction in women at increased risk for BC, which we summarize. We identified five studies (three completed and two ongoing) of combination AI-hormone therapy that are undergoing investigation for BC risk reduction. CONCLUSIONS AIs are effective at BC risk reduction, although long-term follow-up data are required to assess whether this risk reduction will result in reduced mortality. Combination hormone therapy-AI for BC risk reduction is experimental and warrants further investigation.
Collapse
Affiliation(s)
- Lucy Ann Behan
- From the 1Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; 2Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; and 3Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
86
|
Egeland NG, Lunde S, Jonsdottir K, Lende TH, Cronin-Fenton D, Gilje B, Janssen EAM, Søiland H. The Role of MicroRNAs as Predictors of Response to Tamoxifen Treatment in Breast Cancer Patients. Int J Mol Sci 2015; 16:24243-75. [PMID: 26473850 PMCID: PMC4632748 DOI: 10.3390/ijms161024243] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022] Open
Abstract
Endocrine therapy is a key treatment strategy to control or eradicate hormone-responsive breast cancer. However, resistance to endocrine therapy leads to breast cancer relapse. The recent extension of adjuvant tamoxifen treatment up to 10 years actualizes the need for identifying biological markers that may be used to monitor predictors of treatment response. MicroRNAs are promising biomarkers that may fill the gap between preclinical knowledge and clinical observations regarding endocrine resistance. MicroRNAs regulate gene expression by posttranscriptional repression or degradation of mRNA, most often leading to gene silencing. MicroRNAs have been identified directly in the primary tumor, but also in the circulation of breast cancer patients. The few available studies investigating microRNA in patients suggest that seven microRNAs (miR-10a, miR-26, miR-30c, miR-126a, miR-210, miR-342 and miR-519a) play a role in tamoxifen resistance. Ingenuity Pathway Analysis (IPA) reveals that these seven microRNAs interact more readily with estrogen receptor (ER)-independent pathways than ER-related signaling pathways. Some of these pathways are targetable (e.g., PIK3CA), suggesting that microRNAs as biomarkers of endocrine resistance may have clinical value. Validation of the role of these candidate microRNAs in large prospective studies is warranted.
Collapse
Affiliation(s)
- Nina G Egeland
- Department of Pathology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway.
- Department of Mathematics and Natural Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Siri Lunde
- Department of Breast and Endocrine Surgery, Stavanger University Hospital, 4011 Stavanger, Norway.
| | - Kristin Jonsdottir
- Department of Pathology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway.
| | - Tone H Lende
- Department of Breast and Endocrine Surgery, Stavanger University Hospital, 4011 Stavanger, Norway.
- Department of Clinical Science, University of Bergen, Postboks 7804, 5020 Bergen, Norway.
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University, Science Center Skejby, Olof Palmes Allé 43, Aarhus N, 8200 Aarhus, Denmark.
| | - Bjørnar Gilje
- Department of Haematology and Oncology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway.
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway.
- Department of Mathematics and Natural Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Håvard Søiland
- Department of Breast and Endocrine Surgery, Stavanger University Hospital, 4011 Stavanger, Norway.
- Department of Clinical Science, University of Bergen, Postboks 7804, 5020 Bergen, Norway.
| |
Collapse
|
87
|
Santa-Maria CA, Blackford A, Nguyen AT, Skaar TC, Philips S, Oesterreich S, Rae JM, Desta Z, Robarge J, Henry NL, Storniolo AM, Hayes DF, Blumenthal RS, Ouyang P, Post WS, Flockhart DA, Stearns V. Association of Variants in Candidate Genes with Lipid Profiles in Women with Early Breast Cancer on Adjuvant Aromatase Inhibitor Therapy. Clin Cancer Res 2015; 22:1395-402. [PMID: 26463708 DOI: 10.1158/1078-0432.ccr-15-1213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Aromatase inhibitors can exert unfavorable effects on lipid profiles; however, previous studies have reported inconsistent results. We describe the association of single-nucleotide polymorphisms (SNP) in candidate genes with lipid profiles in women treated with adjuvant aromatase inhibitors. EXPERIMENTAL DESIGN We conducted a prospective observational study to test the associations between SNPs in candidate genes in estrogen signaling and aromatase inhibitor metabolism pathways with fasting lipid profiles during the first 3 months of aromatase inhibitor therapy in postmenopausal women with early breast cancer randomized to adjuvant letrozole or exemestane. We performed genetic association analysis and multivariable linear regressions using dominant, recessive, and additive models. RESULTS A total of 303 women had complete genetic and lipid data and were evaluable for analysis. In letrozole-treated patients, SNPs in CYP19A1, including rs4646, rs10046, rs700518, rs749292, rs2289106, rs3759811, and rs4775936 were significantly associated with decreases in triglycerides by 20.2 mg/dL and 39.3 mg/dL (P < 0.00053), respectively, and with variable changes in high-density lipoprotein (HDL-C) from decreases by 4.2 mg/dL to increases by 9.8 mg/dL (P < 0.00053). CONCLUSIONS Variants in CYP19A1 are associated with decreases in triglycerides and variable changes in HDL-C in postmenopausal women on adjuvant aromatase inhibitors. Future studies are needed to validate these findings, and to identify breast cancer survivors who are at higher risk for cardiovascular disease with aromatase inhibitor therapy.
Collapse
Affiliation(s)
| | - Amanda Blackford
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne T Nguyen
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Santosh Philips
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - James M Rae
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Jason Robarge
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Norah Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Pamela Ouyang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | |
Collapse
|
88
|
Abstract
Breast cancer is one of the most common malignancies of women. The majority of breast cancers express estrogen and/or progesterone receptors, permitting anticancer targeting strategies to reduce estrogen signaling in the cancer cells and thereby lowering the risk of breast cancer recurrence. The development of the selective estrogen receptor modulator (SERM) tamoxifen marked a significant milestone in breast cancer care that transcended older estrogen ablative strategies such as oophorectomy and ovarian irradiation. An unintended benefit of tamoxifen in postmenopausal women was bone density preservation. The third generation of aromatase inhibitors (AIs) have demonstrated superior efficacy to tamoxifen in improving disease-free survival in postmenopausal women. However, the AIs significantly increase bone resorption, reduce bone mineral density, and increase the risk of fracture above that of tamoxifen. As a consequence of this, clinical oncologists have assumed a larger role in the screening and treatment of the skeletal complications of breast cancer therapies. The key features of managing bone health in women with early stage breast cancer receiving adjuvant endocrine therapy are reviewed here.
Collapse
Affiliation(s)
- Gregory A Clines
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA,
| | | | | |
Collapse
|
89
|
Zucchini G, Geuna E, Milani A, Aversa C, Martinello R, Montemurro F. Clinical utility of exemestane in the treatment of breast cancer. Int J Womens Health 2015; 7:551-63. [PMID: 26064072 PMCID: PMC4455847 DOI: 10.2147/ijwh.s69475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Breast cancer is the most prevalent cancer in women, causing a significant mortality worldwide. Different endocrine strategies are available for the treatment of hormone-sensitive breast cancer, including antiestrogen tamoxifen and fulvestrant, as well as third-generation aromatase inhibitors (AIs), such as letrozole, anastrozole, and exemestane. In this review, we will focus on exemestane, its clinical use, and its side effects. Exemestane is a steroidal third-generation AI now used in all treatment settings for breast cancer. In the metastatic disease, it has been extensively investigated as the first-, second-, and further-line treatment and it is now registered for the treatment of postmenopausal women with advanced estrogen-receptor-positive breast cancer whose disease has progressed following antiestrogen therapy. A potential lack of cross-resistance with nonsteroidal AIs has been described, giving additional therapeutic opportunities in sequences of endocrine agents. Exemestane is also approved for the adjuvant treatment of postmenopausal early breast cancer, either as upfront monotherapy for 5 years, as a switch following 2–3 years of tamoxifen, or as extended therapy beyond 5 years of adjuvant treatment. New promising data also showed a beneficial effect in young premenopausal early breast cancer patients, when administered together with ovarian suppression. Interesting results have also emerged when exemestane has been investigated as neodjuvant treatment as well as preventive agent in healthy women at high risk for breast cancer. Exemestane is generally well tolerated, with a side effect profile similar to that of other AIs, including menopausal symptoms, arthralgia, and bone loss. In conclusion, exemestane can be considered an effective and well-tolerated endocrine treatment option for all stages of breast cancer.
Collapse
Affiliation(s)
- Giorgia Zucchini
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy
| | - Elena Geuna
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy
| | - Andrea Milani
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy
| | | | | | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia-Candiolo Cancer Institute (IRCCs), Candiolo, Italy
| |
Collapse
|
90
|
Khatri R, Shah P, Guha R, Rassool FV, Tomkinson AE, Brodie A, Jaiswal AK. Aromatase Inhibitor-Mediated Downregulation of INrf2 (Keap1) Leads to Increased Nrf2 and Resistance in Breast Cancer. Mol Cancer Ther 2015; 14:1728-37. [PMID: 25976679 DOI: 10.1158/1535-7163.mct-14-0672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 05/05/2015] [Indexed: 12/23/2022]
Abstract
Aromatase inhibitors are effective drugs that reduce or eliminate hormone-sensitive breast cancer. However, despite their efficacy, resistance to these drugs can occur in some patients. The INrf2 (Keap1):Nrf2 complex serves as a sensor of drug/radiation-induced oxidative/electrophilic stress. INrf2 constitutively suppresses Nrf2 by functioning as an adapter protein for the Cul3/Rbx1-mediated ubiquitination/degradation of Nrf2. Upon stress, Nrf2 dissociates from INrf2, is stabilized, translocates to the nucleus, and coordinately induces a battery of cytoprotective gene expression. Current studies investigated the role of Nrf2 in aromatase inhibitor resistance. RT-PCR and immunoblot assays showed that aromatase inhibitor-resistant breast cancer LTLTCa and AnaR cells express lower INrf2 and higher Nrf2 protein levels, as compared with drug-sensitive MCF-7Ca and AC1 cells, respectively. The increase in Nrf2 was due to lower ubiquitination/degradation of Nrf2 in aromatase inhibitor-resistant cells. Higher Nrf2-mediated levels of biotransformation enzymes, drug transporters, and antiapoptotic proteins contributed to reduced efficacy of drugs and aversion to apoptosis that led to drug resistance. shRNA inhibition of Nrf2 in LTLTCa (LTLTCa-Nrf2KD) cells reduced resistance and sensitized cells to aromatase inhibitor exemestane. Interestingly, LTLTCa-Nrf2KD cells also showed reduced levels of aldehyde dehydrogenase, a marker of tumor-initiating cells and significantly decreased mammosphere formation, as compared with LTLTCa-Vector control cells. The results together suggest that persistent aromatase inhibitor treatment downregulated INrf2 leading to higher expression of Nrf2 and Nrf2-regulated cytoprotective proteins that resulted in increased aromatase inhibitor drug resistance. These findings provide a rationale for the development of Nrf2 inhibitors to overcome resistance and increase efficacy of aromatase inhibitors.
Collapse
Affiliation(s)
- Raju Khatri
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Preeti Shah
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rupa Guha
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Feyruz V Rassool
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alan E Tomkinson
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Angela Brodie
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anil K Jaiswal
- Department of Pharmacology and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
91
|
Ottanelli S. Prevention and treatment of bone fragility in cancer patient. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2015; 12:116-29. [PMID: 26604936 PMCID: PMC4625767 DOI: 10.11138/ccmbm/2015.12.2.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is well known that fractures increase the risk of morbidity and mortality. The various mechanisms responsible for bone loss in cancer patients may have a different impact depending on the characteristics of the clinical case and correlates with the therapies used, or caused by the therapies used against cancer. Some hormonal treatments cause hypogonadism, event which contributes to the progressive loss of bone mass. This is detectable in patients with breast cancer receiving determines that estrogen-deprivation and in men with prostate cancer with therapies that determine androgen deprivation. Chemotherapy treatments used in cancer patients have reduced bone mass. In addition, low bone mass is detectable in patients with lymphoma treated with corticosteroids or radiation or alkylating agents. In premenopausal patients suffering from breast cancer, treatment with cytotoxic therapy or ablation of ovarian function, can lead to an 8% reduction in bone mineral density at the spine and 4% in the femur. With a chemotherapy regimen in CMF, the reduction of BMD is 6.5%; this bone loss is not recovered after discontinuation of therapy. Tamoxifen given for five years reduces bone remodeling and cause a 32% increase in the risk of osteoporotic fractures when used in premenopausal. After menopause, tamoxifen has a protective effect on bone mass, with a reduced risk of new fractures. Aromatase inhibitors in post-menopausal women, depending on the formulation can cause different effects on the reduction of BMD and fracture risk. We have in fact steroids, exemestane and nonsteroidal, letrozole and anastrozole. Patients at increased risk of fragility fractures should undergo preventive therapies as soon as possible after tests performed for the study of bone health. They can be used DEXA and the FRAX algorithm, which can define a secondary osteoporosis. Prevention and treatment of the increased risk of osteoporotic fracture is to maintain adequate levels of calcium and vitamin D. Bisphosphonates and denosumab are used for the management of bone remodeling and bone loss induced by cancer treatments. Bisphosphonates also have anti-tumor effects per se, which are expressed in potentially prevent the development of bone metastases. In men with metastatic prostate cancer and which is induced androgen deprivation, it is usefully used denosumab 120 mg monthly or zoledronic acid 4 mg monthly.
Collapse
Affiliation(s)
- Silva Ottanelli
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| |
Collapse
|
92
|
Hayes EL, Lewis-Wambi JS. Mechanisms of endocrine resistance in breast cancer: an overview of the proposed roles of noncoding RNA. Breast Cancer Res 2015; 17:40. [PMID: 25849966 PMCID: PMC4362832 DOI: 10.1186/s13058-015-0542-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022] Open
Abstract
Endocrine therapies such as tamoxifen and aromatase inhibitors are the standard treatment options for estrogen receptor-positive breast cancer patients. However, resistance to these agents has become a major clinical obstacle. Potential mechanisms of resistance to endocrine therapies have been identified, often involving enhanced growth factor signaling and changes in the expression or action of the estrogen receptor, but few studies have addressed the role of noncoding RNA (ncRNA). Two important types of ncRNA include microRNA (miRNA) and long noncoding RNA (lncRNA). miRNAs are small RNA molecules that regulate gene expression via translational inhibition or degradation of mRNA transcripts, while lncRNAs are larger RNA molecules that have been shown to play a role in multiple cellular maintenance functions such as protein scaffolding, chromatin looping, and regulation of mRNA stability. Both miRNA and lncRNA have recently impacted the field of breast cancer research as important pieces in the mechanistic puzzle of the genes and pathways involved in breast cancer development and progression. This review serves as an overview of the roles of miRNA and lncRNA in breast cancer progression and the development of endocrine resistance. Ideally, future experiments in the field should include identification of ncRNAs that could be potential therapeutic targets in endocrine-resistant tumors, as well as ncRNA biomarkers that facilitate more tumor-specific treatment options for endocrine-resistant breast cancer patients.
Collapse
|
93
|
Abstract
Adjuvant endocrine therapy reduces the risk of recurrence and death from breast cancer in women with hormone receptor-positive early breast cancer. Tamoxifen has been the standard therapy for decades, and this is still the case for pre-menopausal women. Ovarian suppression is of similar efficacy but currently there is no strong evidence for adding this to tamoxifen and the additional morbidity can be considerable. Results from two important trials addressing this issue are imminent. In post-menopausal women, aromatase inhibitors (AIs) (letrozole, anastrozole, or exemestane) are superior to tamoxifen in preventing recurrence but only letrozole has been shown to improve survival. The main gain is against high-risk cancers, and tamoxifen gives very similar benefit for low-risk disease. Traditionally, treatment has been given for around 5 years, but many women remain at risk of relapse for 10 years or more. The AIs, and more recently tamoxifen, have been shown to reduce further the risk of late recurrence in women still in remission after 5 years of tamoxifen if given for a further 5 years. The comparative benefits of these two options and the selection of patients most likely to benefit from long-term adjuvant endocrine therapy are important topics for further research, as is the optimum duration of AI therapy started upfront.
Collapse
|
94
|
Goldfarb S. Endocrine therapy and its effect on sexual function. Am Soc Clin Oncol Educ Book 2015:e575-e581. [PMID: 25993225 DOI: 10.14694/edbook_am.2015.35.e575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
KEY POINTS Breast cancer and its treatment, especially endocrine therapy, can cause sexual dysfunction, which is often multifactorial in nature with both a physical and mental component. Clinicians should discuss sexual health with all women with breast cancer and survivors of the disease. Women with breast cancer often experience premature menopause, which causes greater intensity and duration of symptoms than women undergoing natural menopause. Hot flashes, vaginal dryness, urogenital atrophy, dyspareunia, decreased libido, and changes in sexual response have been shown to negatively affect quality of life, compliance with medication, and overall outcome. Treatment options for sexual dysfunction in women with breast cancer depend on the etiology of the problem and concomitant medical conditions. Some possible treatments include: lubricants, moisturizers, counseling, sex therapy, altering contributing medications, physical therapy for pelvic floor disorders, and mechanical devices/vibrators.
Collapse
Affiliation(s)
- Shari Goldfarb
- From the Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College
| |
Collapse
|
95
|
Choi J, Psarommatis B, Gao YR, Zheng Y, Handelsman DJ, Simanainen U. The role of androgens in experimental rodent mammary carcinogenesis. Breast Cancer Res 2014; 16:483. [PMID: 25928046 PMCID: PMC4429669 DOI: 10.1186/s13058-014-0483-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is currently the most frequent, fatal cancer of women in western countries. While estrogens have a widely understood involvement in breast cancer, a significant but not yet fully understood role for androgens has also been suggested. The principal androgen, testosterone, is the obligate steroidal precursor of estradiol, but can equally be metabolized into dihydrotestosterone, a more potent, pure androgen. Both androgens exert their distinctive biological effects via the androgen receptor, which is coexpressed with estrogen receptor alpha in 80 to 90% of breast cancers. The hormonal control of breast development and pathology has been examined experimentally through the use of animal models, notably mice and rats. This review summarizes the data from experimental rodent models on the effects of androgens in experimental breast cancer, aiming to address the importance of androgens and the androgen receptor in the origins and pathogenesis of breast cancers, as well as to discuss potential biomarker and therapeutic opportunities arising from novel insights based on the experimental research.
Collapse
Affiliation(s)
- Jaesung Choi
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| | - Basil Psarommatis
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| | - Yan Ru Gao
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| | - Yu Zheng
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| | - Ulla Simanainen
- ANZAC Research Institute, University of Sydney, Sydney, NSW, 2139, Australia.
| |
Collapse
|
96
|
Zhou F, Han S, Zhou N, Zheng W, Li P. Effects of modified Shu-Gan-Liang-Xue decoction combined with anastrozole on osteoblastic proliferation and differentiation of MC3T3-E1 cells. Mol Med Rep 2014; 11:1639-46. [PMID: 25405542 PMCID: PMC4270318 DOI: 10.3892/mmr.2014.2962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 10/17/2014] [Indexed: 01/18/2023] Open
Abstract
Aromatase inhibitors (AIs) are widely used in the treatment of hormone-dependent breast cancer and as a result, aromatase inhibitor-associated bone loss (AIBL) has become a major concern amongst patients receiving AI treatment. Modified Shu-Gan-Liang-Xue decoction (mSGLXD), a clinical prescription, has been used for ameliorating AIBL in patients with breast cancer for decades and has achieved good clinical efficacy. However, the mechanism underlying how mSGLXD influences bone homeostasis and alleviates AIBL has remained elusive. In the present study, mSGLXD was supplemented with Rhizoma Drynariae containing phytoestrogens, and the safety of mSGLXD was evaluated. mSGLXD did not possess estrogenic activity and significantly inhibited the proliferation of estrogen receptor-positive breast cancer cell line MCF-7, which suggested that mSGLXD was safe for postmenopausal patients with breast cancer. Subsequently, the effects of mSGLXD alone or in combination with anastrozole on osteoblastic MC3T3-E1 cell proliferation and differentiation were investigated. Cell counting kit-8, reverse transcription-polymerase chain reaction and biochemical methods, such as ELISA and alizarin red S staining, were used in the present study. It was revealed that mSGLXD not only stimulated MC3T3-E1 cell proliferation, but also upregulated alkaline phosphatase and osteocalcin gene and protein expression levels. High concentrations of anastrozole (10 or 100 μmol/l) markedly inhibited MC3T3-E1 cell proliferation, but this inhibitory effect was attenuated by mSGLXD. Furthermore, mSGLXD increased MC3T3-E1 cell mineralization following β-glycerophosphate and ascorbic acid induction. Therefore, the results of the present study suggested that mSGLXD may be a promising adjuvant therapy, with high safety and efficacy, for the prevention and treatment of AIBL in patients with breast cancer who receive AI treatment.
Collapse
Affiliation(s)
- Fei Zhou
- Key Laboratory of Carcinogenesis and Traditional Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Shuyan Han
- Key Laboratory of Carcinogenesis and Traditional Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Ning Zhou
- Key Laboratory of Carcinogenesis and Traditional Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Wenxian Zheng
- Key Laboratory of Carcinogenesis and Traditional Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Pingping Li
- Key Laboratory of Carcinogenesis and Traditional Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| |
Collapse
|
97
|
Schwarz LJ, Fox EM, Balko JM, Garrett JT, Kuba MG, Estrada MV, González-Angulo AM, Mills GB, Red-Brewer M, Mayer IA, Abramson V, Rizzo M, Kelley MC, Meszoely IM, Arteaga CL. LYN-activating mutations mediate antiestrogen resistance in estrogen receptor-positive breast cancer. J Clin Invest 2014; 124:5490-502. [PMID: 25401474 DOI: 10.1172/jci72573] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/16/2014] [Indexed: 12/17/2022] Open
Abstract
Estrogen receptor-positive (ER(+)) breast cancers adapt to hormone deprivation and become resistant to antiestrogen therapy. Here, we performed deep sequencing on ER(+) tumors that remained highly proliferative after treatment with the aromatase inhibitor letrozole and identified a D189Y mutation in the inhibitory SH2 domain of the SRC family kinase (SFK) LYN. Evaluation of 463 breast tumors in The Cancer Genome Atlas revealed four LYN mutations, two of which affected the SH2 domain. In addition, LYN was upregulated in multiple ER(+) breast cancer lines resistant to long-term estrogen deprivation (LTED). An RNAi-based kinome screen revealed that LYN is required for growth of ER(+) LTED breast cancer cells. Kinase assays and immunoblot analyses of SRC substrates in transfected cells indicated that LYN(D189Y) has higher catalytic activity than WT protein. Further, LYN(D189Y) exhibited reduced phosphorylation at the inhibitory Y507 site compared with LYN(WT). Other SH2 domain LYN mutants, E159K and K209N, also exhibited higher catalytic activity and reduced inhibitory site phosphorylation. LYN(D189Y) overexpression abrogated growth inhibition by fulvestrant and/or the PI3K inhibitor BKM120 in 3 ER(+) breast cancer cell lines. The SFK inhibitor dasatinib enhanced the antitumor effect of BKM120 and fulvestrant against estrogen-deprived ER(+) xenografts but not LYN(D189Y)-expressing xenografts. These results suggest that LYN mutations mediate escape from antiestrogens in a subset of ER(+) breast cancers.
Collapse
MESH Headings
- Amino Acid Substitution
- Aminopyridines/agonists
- Aminopyridines/pharmacology
- Animals
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Dasatinib
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Drug Synergism
- Estrogen Receptor Modulators/pharmacology
- Female
- Gene Expression Regulation, Enzymologic/drug effects
- Gene Expression Regulation, Enzymologic/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Mice
- Mice, Nude
- Morpholines/agonists
- Morpholines/pharmacology
- Mutation, Missense
- Phosphatidylinositol 3-Kinases/genetics
- Phosphatidylinositol 3-Kinases/metabolism
- Phosphoinositide-3 Kinase Inhibitors
- Phosphorylation/drug effects
- Phosphorylation/genetics
- Protein Kinase Inhibitors/pharmacology
- Pyrimidines/agonists
- Pyrimidines/pharmacology
- Receptors, Estrogen/genetics
- Receptors, Estrogen/metabolism
- Thiazoles/agonists
- Thiazoles/pharmacology
- Xenograft Model Antitumor Assays
- src Homology Domains
- src-Family Kinases/genetics
- src-Family Kinases/metabolism
Collapse
|
98
|
Neely EK, Kumar RB, Payne SL, Ranadive SA, Suchet DI. Letrozole vs anastrozole for height augmentation in short pubertal males: first year data. J Clin Endocrinol Metab 2014; 99:4086-93. [PMID: 25137428 DOI: 10.1210/jc.2014-2432] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Aromatase inhibitors are used off-label to treat short stature in peripubertal boys. OBJECTIVE To investigate short- and long-term hormonal and auxologic differences in short pubertal boys treated with letrozole (L) or anastrozole (A). DESIGN PATIENTS are seen for laboratory evaluation and physical examination every 6 months, bone age yearly, DEXA and spine film every 2 years. They will be followed until they reach their final height. This is a preliminary report after 1 year of treatment. SETTING A single academic children's hospital outpatient clinic. PATIENTS Boys with age >10 years, bone age ≤ 14 years, clinical and hormonal evidence of central puberty, and either height < fifth percentile or predicted adult height (PAH) more than 10 cm below mid-parental height (MPH). INTERVENTION Letrozole (2.5 mg) or anastrozole (1 mg) was administered orally each day. MAIN OUTCOME MEASURES Hormonal and clinical parameters, growth velocity, and change in bone age and PAH. RESULTS Thirty-nine boys have completed 1 year of treatment. Baseline means were age 14.1 years, PAH 166 cm, and testosterone 198 ng/dL. At 1 year, letrozole resulted in higher LH (L 6.1 ± 2.5 vs A 3.2 ± 1.7 IU/L) and testosterone (1038 ± 348 vs 536 ± 216 ng/dL) with lower estradiol (2.8 ± 2.8 vs 5.6 ± 2.9 pg/mL) and IGF-1 (237 ± 51 vs 331 ± 79 ng/mL). First year growth velocities were identical (7.2 cm/year), but an increase in PAH was greater in the anastrozole group (4.2 ± 3.5 vs 1.4 ± 4.4 cm, p = 0.03) after 1 year. CONCLUSIONS We present first-year data from a direct comparison of anastrozole and letrozole for height augmentation in short pubertal boys. Letrozole was more potent in hormonal manipulation than anastrozole. First-year growth velocities were comparable, but improvement in PAH was greater in the anastrozole group. It remains to be seen if positive PAH trends will translate to increase in final height in either group.
Collapse
Affiliation(s)
- E Kirk Neely
- Pediatric Endocrinology (E.K.N., R.B.K., S.L.P.), Stanford University Medical Center, Stanford, California 94305; and Pediatric Endocrinology (S.A.R., D.I.S.), Palo Alto Medical Foundation, Palo Alto, California 94301
| | | | | | | | | |
Collapse
|
99
|
Ghorbanpoor S, Garcia-Segura LM, Haeri-Rohani A, Khodagholi F, Jorjani M. Aromatase inhibition exacerbates pain and reactive gliosis in the dorsal horn of the spinal cord of female rats caused by spinothalamic tract injury. Endocrinology 2014; 155:4341-55. [PMID: 25105782 DOI: 10.1210/en.2014-1158] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Central pain syndrome is characterized by severe and excruciating pain resulting from a lesion in the central nervous system. Previous studies have shown that estradiol decreases pain and that inhibitors of the enzyme aromatase, which synthesizes estradiol from aromatizable androgens, increases pain sensitivity. In this study we have assessed whether aromatase expression in the dorsal horns of the spinal cord is altered in a rat model of central pain syndrome, induced by the unilateral electrolytic lesion of the spinothalamic tract. Protein and mRNA levels of aromatase, as well as the protein and mRNA levels of estrogen receptors α and β, were increased in the dorsal horn of female rats after spinothalamic tract injury, suggesting that the injury increased estradiol synthesis and signaling in the dorsal horn. To determine whether the increased aromatase expression in this pain model may participate in the control of pain, mechanical allodynia thresholds were determined in both hind paws after the intrathecal administration of letrozole, an aromatase inhibitor. Aromatase inhibition enhanced mechanical allodynia in both hind paws. Because estradiol is known to regulate gliosis we assessed whether the spinothalamic tract injury and aromatase inhibition regulated gliosis in the dorsal horn. The proportion of microglia with a reactive phenotype and the number of glial fibrillary acidic protein-immunoreactive astrocytes were increased by the injury in the dorsal horn. Aromatase inhibition enhanced the effect of the injury on gliosis. Furthermore, a significant a positive correlation of mechanical allodynia and gliosis in the dorsal horn was detected. These findings suggest that aromatase is up-regulated in the dorsal horn in a model of central pain syndrome and that aromatase activity in the spinal cord reduces mechanical allodynia by controlling reactive gliosis in the dorsal horn.
Collapse
Affiliation(s)
- Samar Ghorbanpoor
- Department of Cell and Molecular Biology (S.G.), Department of Animal Biology (A.H.-R.), School of Biology, College of Science (S.G.), University of Tehran, Tehran, Iran; Consejo Superior de Investigaciones Científicas (L.M.G.-S.), Instituto Cajal, E-28002 Madrid, Spain; Neurobiology Research Center (F.K., M.J.), Shahid Beheshti University of Medical Sciences, Tehran, Iran; and Department of Pharmacology, Faculty of Medicine (M.J.), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
100
|
Bone health history in breast cancer patients on aromatase inhibitors. PLoS One 2014; 9:e111477. [PMID: 25354083 PMCID: PMC4213031 DOI: 10.1371/journal.pone.0111477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/11/2014] [Indexed: 11/20/2022] Open
Abstract
A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI) users before breast cancer (BC) diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC). Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001). Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures.
Collapse
|