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Liang E, Beshara M, Sheng H, Huang XW, Roh JM, Laurent CA, Lee C, Delmerico J, Tang L, Lo JC, Hong CC, Ambrosone CB, Kushi LH, Kwan ML, Yao S. A prospective study of vitamin D, proinflammatory cytokines, and risk of fragility fractures in women on aromatase inhibitors for breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07423-6. [PMID: 38976164 DOI: 10.1007/s10549-024-07423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Vitamin D is critical to bone health by regulating intestinal absorption of calcium, whereas proinflammatory cytokines, including IL-1, IL-6, IL-12, and TNF-α, are known to increase bone resorption. We hypothesized that vitamin D and these cytokines at the time of breast cancer diagnosis were predictive for fragility fractures in women receiving aromatase inhibitors (AIs). METHODS In a prospective cohort of 1,709 breast cancer patients treated with AIs, we measured the levels of 25-hydroxyvitamin D (25OHD), IL-1β, IL-6, IL-12, and TNF-α from baseline blood samples. The associations of these biomarkers were analyzed with bone turnover markers (BALP and TRACP), bone regulatory markers (OPG and RANKL), bone mineral density (BMD) close to cancer diagnosis, and risk of fragility fractures during a median of 7.5 years of follow up. RESULTS Compared to patients with vitamin D deficiency, patients with sufficient levels had higher bone turnover, lower BMD, and higher fracture risk; the latter became non-significant after controlling for covariates including BMD and no longer existed when patients taking vitamin D supplement or bisphosphonates or with history of fracture or osteoporosis were excluded. There was a non-significant trend of higher levels of IL-1β and TNF-α associated with higher risk of fracture (highest vs. lowest tertile, IL-1β: adjusted HR=1.37, 95% CI=0.94-1.99; TNF-α: adjusted HR=1.38, 95% CI=0.96-1.98). CONCLUSIONS Our results do not support proinflammatory cytokines or vitamin D levels as predictors for risk of fragility fractures in women receiving AIs for breast cancer.
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Affiliation(s)
- Emily Liang
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Beshara
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Haiyang Sheng
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- Department of Biostatistics, University at Buffalo, Buffalo, NY, USA
| | - Xin-Wei Huang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- Department of Biostatistics, University at Buffalo, Buffalo, NY, 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
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jennifer Delmerico
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 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
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
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Kim S, Chen N, Reid P. Current and future advances in practice: aromatase inhibitor-induced arthralgia. Rheumatol Adv Pract 2024; 8:rkae024. [PMID: 38601139 PMCID: PMC11003819 DOI: 10.1093/rap/rkae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024] Open
Abstract
Aromatase inhibitors (AIs) have shown great success as adjuvant therapy for post-menopausal women with hormone receptor-positive breast cancers. AI-induced arthralgia (AIA) is a frequent AI toxicity contributing to non-adherence and discontinuation. This review aims to understand current knowledge of AIA. The mean incidence of AIA was 39.1% and the mean discontinuation of AI therapy due to AIA was 9.3%. Most of the AIAs were non-inflammatory. A shorter time since the last menstrual period and pre-existing joint pain were risk factors. Vitamin D3 supplementation may be a preventative measure and treatment with duloxetine, acupuncture and/or exercise is supported by large randomized controlled trials. There was consistent improvement in AIAs with switching to an alternate AI, and this could additionally allow continuation of cancer treatment with AI. Further research is needed to identify predictive biomarkers, better characterize AIA subcategories and study more reliable therapeutic options.
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Affiliation(s)
- Sara Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nan Chen
- Division of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Pankti Reid
- Division of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL, USA
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Okunola AO, Baatjes KJ, Zemlin AE, Torrorey-Sawe R, Conradie M, Kidd M, Erasmus RT, van der Merwe NC, Kotze MJ. Pathology-supported genetic testing for the application of breast cancer pharmacodiagnostics: family counselling, lifestyle adjustments and change of medication. Expert Rev Mol Diagn 2023; 23:431-443. [PMID: 37060281 DOI: 10.1080/14737159.2023.2203815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Pathology-supported genetic testing (PSGT) enables transitioning of risk stratification from the study population to the individual. RESEARCH DESIGN AND METHODS We provide an overview of the translational research performed in postmenopausal breast cancer patients at increased risk of osteoporosis due to aromatase inhibitor therapy, as the indication for referral. Both tumour histopathology and blood biochemistry levels were assessed to identify actionable disease pathways using whole exome sequencing (WES). RESULTS The causes and consequences of inadequate vitamin D levels as a modifiable risk factor for bone loss were highlighted in 116 patients with hormone receptor-positive breast cancer. Comparison of lifestyle factors and WES data between cases with vitamin D levels at extreme upper and lower ranges identified obesity as a major discriminating factor, with the lowest levels recorded during winter. Functional polymorphisms in the vitamin D receptor gene contributed independently to therapy-related osteoporosis risk. In a patient with invasive lobular carcinoma, genetic counselling facilitated investigation of the potential modifying effect of a rare CDH1 variant co-occurring withBRCA1 c.66dup (p.Glu23ArgfsTer18). CONCLUSION Validation of PSGT as a three-pronged pharmacodiagnostics tool for generation of adaptive reports and data reinterpretation during follow-up represents a new paradigm in personalised medicine, exposing significant limitations to overcome.
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Affiliation(s)
- Abisola O Okunola
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karin J Baatjes
- Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Rispah Torrorey-Sawe
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Immunology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Magda Conradie
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nerina C van der Merwe
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Human Genetics, National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Castañeda S, Casas A, González-Del-Alba A, Martínez-Díaz-Guerra G, Nogués X, Ojeda Thies C, Torregrosa Suau Ó, Rodríguez-Lescure Á. Bone loss induced by cancer treatments in breast and prostate cancer patients. Clin Transl Oncol 2022; 24:2090-2106. [PMID: 35779210 PMCID: PMC9522722 DOI: 10.1007/s12094-022-02872-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Abstract
Cancer and cancer therapies are a major factor risk for osteoporosis due to bone loss and deterioration of bone microarchitecture. Both factors contribute to a decrease in bone strength and, consequently, increased bone fragility and risk of fracture. Cancer-associated bone loss is a multifactorial process, and optimal interdisciplinary management of skeletal health, accurate assessment of bone density, and early diagnosis are essential when making decisions aimed at reducing bone loss and fracture risk in patients who have received or are receiving treatment for cancer. In this document, a multidisciplinary group of experts collected the latest evidence on the pathophysiology of osteoporosis and its prevention, diagnosis, and treatment with the support of the Spanish scientific society SEOM. The aim was to provide an up-to-date and in-depth view of osteoporotic risk and its consequences, and to present a series of recommendations aimed at optimizing the management of bone health in the context of cancer.
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Affiliation(s)
- Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Catedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Casas
- Department of Medical Oncology, Hospital Virgen del Rocío, Seville, Spain
| | | | - Guillermo Martínez-Díaz-Guerra
- Department of Endocrinology and Nutrition, Instituto de Investigación imas12, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universidad Pompeu Fabra, Barcelona, Spain
| | - Cristina Ojeda Thies
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Óscar Torregrosa Suau
- Department of Internal Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Álvaro Rodríguez-Lescure
- Department of Medical Oncology, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03202, Alicante, Spain.
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Filip-Psurska B, Zachary H, Strzykalska A, Wietrzyk J. Vitamin D, Th17 Lymphocytes, and Breast Cancer. Cancers (Basel) 2022; 14:cancers14153649. [PMID: 35954312 PMCID: PMC9367508 DOI: 10.3390/cancers14153649] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The effect of vitamin D3 on the development of breast cancer (favorable, ineffective, or even unfavorable) depends on many factors, such as age, menopausal status, or obesity. The immunomodulatory effect of vitamin D may be unfavorable in case of breast cancer progression. The effect of vitamin D on Th17 cells may depend on disease type and patients’ age. Our goal was to summarize the data available and to find indications of vitamin D treatment failure or success. Therefore, in this review, we present data describing the effects of vitamin D3 on Th17 cells, mainly in breast cancer. Abstract Vitamin D3, which is well known to maintain calcium homeostasis, plays an important role in various cellular processes. It regulates the proliferation and differentiation of several normal cells, including immune and neoplastic cells, influences the cell cycle, and stimulates cell maturation and apoptosis through a mechanism dependent on the vitamin D receptor. The involvement of vitamin D3 in breast cancer development has been observed in numerous clinical studies. However, not all studies support the protective effect of vitamin D3 against the development of this condition. Furthermore, animal studies have revealed that calcitriol or its analogs may stimulate tumor growth or metastasis in some breast cancer models. It has been postulated that the effect of vitamin D3 on T helper (Th) 17 lymphocytes is one of the mechanisms promoting metastasis in these murine models. Herein we present a literature review on the existing data according to the interplay between vitamin D, Th17 cell and breast cancer. We also discuss the effects of this vitamin on Th17 lymphocytes in various disease entities known to date, due to the scarcity of scientific data on Th17 lymphocytes and breast cancer. The presented data indicate that the effect of vitamin D3 on breast cancer development depends on many factors, such as age, menopausal status, or obesity. According to that, more extensive clinical trials and studies are needed to assess the importance of vitamin D in breast cancer, especially when no correlations seem to be obvious.
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Oza S. Aromatase Inhibitor-induced Musculoskeletal Syndrome: a Review of Rehabilitation Interventions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alkhalaf Z, Kim K, Kuhr DL, Radoc JG, Purdue-Smithe A, Pollack AZ, Yisahak SF, Silver RM, Thoma M, Kissell K, Perkins NJ, Sjaarda LA, Mumford SL. Markers of vitamin D metabolism and premenstrual symptoms in healthy women with regular cycles. Hum Reprod 2021; 36:1808-1820. [PMID: 33864070 DOI: 10.1093/humrep/deab089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Are insufficient 25-hydroxyvitamin D (25(OH)D) concentrations, and other markers of vitamin D metabolism, associated with premenstrual symptoms in healthy women with regular menstrual cycles? SUMMARY ANSWER 25(OH)D insufficiency was associated with specific physical premenstrual symptoms, while no associations were observed with psychological symptoms or with other markers of vitamin D metabolism. WHAT IS KNOWN ALREADY Prior studies evaluating vitamin D and premenstrual symptoms have yielded mixed results, and it is unknown whether 25(OH)D insufficiency and other markers of vitamin D metabolism are associated with premenstrual symptoms. STUDY DESIGN, SIZE, DURATION We used two cohorts of women with regular menstrual cycles; 1191 women aged 18-40 years in EAGeR (cross-sectional analysis of a prospective cohort within a randomized trial) and 76 women aged 18-44 years in BioCycle (prospective cohort). In EAGeR, premenstrual symptoms over the previous year were assessed at baseline, whereas in BioCycle, symptoms were assessed prospectively at multiple points over two menstrual cycles with symptoms queried over the previous week. In both cohorts, symptomatology was assessed via questionnaire regarding presence and severity of 14 physical and psychological symptoms the week before and after menses. Both studies measured 25(OH)D in serum. We also evaluated the association of additional markers of vitamin D metabolism and calcium homeostasis, including intact parathyroid hormone (iPTH), calcium (Ca), fibroblast growth factor 23 (FGF23), and 1,25 dihydroxyvitamin D (1,25(OH)2D) with premenstrual symptoms in the BioCycle cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS One cohort of women actively seeking pregnancy (Effects of Aspirin in Gestation and Reproduction (EAGeR)) and one cohort not seeking pregnancy (BioCycle) were evaluated. Log-binomial regression was used to estimate risk ratios (RR) and 95% CIs for associations between insufficient 25(OH)D (<30 ng/ml) and individual premenstrual symptoms, adjusting for age, BMI, race, smoking, income, physical activity, and season of blood draw. MAIN RESULTS AND THE ROLE OF CHANCE 25(OH)D insufficiency was associated with increased risk of breast fullness/tenderness (EAGeR RR 1.27, 95% CI 1.03, 1.55; BioCycle RR 1.37, 95% CI 0.56, 3.32) and generalized aches and pains (EAGeR RR 1.33, 95% CI 1.01, 1.78; BioCycle 1.36, 95% CI 0.41, 4.45), though results were imprecise in the BioCycle study. No associations were observed between insufficient 25(OH)D and psychological symptoms in either cohort. In BioCycle, iPTH, Ca, FGF23, and 1,25(OH) 2D were not associated with any premenstrual symptoms. LIMITATIONS, REASONS FOR CAUTION Results from the EAGeR study were limited by the study design, which assessed both 25(OH)D at baseline and individual premenstrual symptoms over the past year at the baseline. As such, reverse causality is a potential concern. Though premenstrual symptoms were assessed prospectively in the BioCycle cohort, the power was limited due to small sample size. However, results were fairly consistent across both studies. WIDER IMPLICATIONS OF THE FINDINGS Serum 25(OH)D may be associated with risk and severity of specific physical premenstrual symptoms. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland (Contract nos. HHSN267200603423, HHSN267200603424, and HHSN267200603426). JG.R. and D.L.K. have been funded by the NIH Medical Research Scholars Program, a public-private partnership jointly supported by the NIH and generous contributions to the Foundation for the NIH by the Doris Duke Charitable Foundation (Grant #2014194), the American Association for Dental Research, the Colgate Palmolive Company, Genentech, and other private donors. For a complete list, visit the foundation website at http://www.fnih.org. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT00467363.
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Affiliation(s)
- Z Alkhalaf
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA.,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - K Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - D L Kuhr
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J G Radoc
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - A Purdue-Smithe
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - A Z Pollack
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - S F Yisahak
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - R M Silver
- Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - M Thoma
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA
| | - K Kissell
- Department of Endocrinology, Diabetes and Metabolism, Guthrie Medical Group, PC, Sayre, PA, USA
| | - N J Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - L A Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - S L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Filip-Psurska B, Psurski M, Anisiewicz A, Libako P, Zbrojewicz E, Maciejewska M, Chodyński M, Kutner A, Wietrzyk J. Vitamin D Compounds PRI-2191 and PRI-2205 Enhance Anastrozole Activity in Human Breast Cancer Models. Int J Mol Sci 2021; 22:ijms22052781. [PMID: 33803480 PMCID: PMC7967212 DOI: 10.3390/ijms22052781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
1,25-Dihydroxycholecalciferol, the hormonally active vitamin D3 metabolite, is known to exhibit therapeutic effects against breast cancer, mainly by lowering the expression of estrogen receptors and aromatase activity. Previously, the safety of the vitamin D active metabolite (24R)-1,24-dihydroxycholecalciferol (PRI-2191) and 1,25(OH)2D3 analog PRI-2205 was tested, and the in vitro activity of these analogs against different cancer cell lines was studied. We determined the effect of the two vitamin D compounds on anastrozole (An) activity against breast cancer based on antiproliferative activity, ELISA, flow cytometry, enzyme inhibition potency, PCR, and xenograft study. Both the vitamin D active metabolite and synthetic analog regulated the growth of not only estrogen receptor-positive cells (T47D and MCF-7, in vitro and in vivo), but also hormone-independent cancer cells such as SKBR-3 (HER-2-positive) and MDA-MB-231 (triple-negative), despite their relatively low VDR expression. Combined with An, PRI-2191 and PRI-2205 significantly inhibited the tumor growth of MCF-7 cells. Potentiation of the antitumor activity in combined treatment of MCF-7 tumor-bearing mice is related to the reduced activity of aromatase by both An (enzyme inhibition) and vitamin D compounds (switched off/decreased aromatase gene expression, decreased expression of other genes related to estrogen signaling) and by regulation of the expression of the estrogen receptor ERα and VDR.
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Affiliation(s)
- Beata Filip-Psurska
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
- Correspondence:
| | - Mateusz Psurski
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
| | - Artur Anisiewicz
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
| | - Patrycja Libako
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
| | - Ewa Zbrojewicz
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
| | - Magdalena Maciejewska
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
| | - Michał Chodyński
- Łukasiewicz Research Network-Industrial Chemistry Institute, 8 Rydygiera, 01-793 Warsaw, Poland;
| | - Andrzej Kutner
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha, 02-097 Warsaw, Poland;
| | - Joanna Wietrzyk
- Department of Experimental Oncology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigl, 53-114 Wroclaw, Poland; (M.P.); (A.A.); (P.L.); (E.Z.); (M.M.); (J.W.)
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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Single Nucleotide Polymorphisms in 25-Hydroxyvitamin D3 1-Alpha-Hydroxylase ( CYP27B1) Gene: The Risk of Malignant Tumors and Other Chronic Diseases. Nutrients 2020; 12:nu12030801. [PMID: 32197412 PMCID: PMC7146376 DOI: 10.3390/nu12030801] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022] Open
Abstract
: Vitamin D is widely known for its roles in the promotion of apoptosis and differentiation, with simultaneous inhibition of proliferation, inflammation, angiogenesis, invasion, and metastasis. Modern literature lacks complete information on polymorphisms in CYP27B1, the only enzyme capable of vitamin D activation. This review presents gathered data that relate to genetic variants in CYP27B1 gene in correlation to multiple diseases, mostly concerning colorectal, prostate, breast, lung, and pancreatic cancers, as well as on other pathologies, such as non-Hodgkin's lymphoma, oral lichen planus, or multiple sclerosis.
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Hack CC, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Almstedt K, Gass P, Heindl F, Brodkorb T, Willer L, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA, Nabieva N. Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients. Breast 2020; 50:11-18. [PMID: 31958661 PMCID: PMC7377331 DOI: 10.1016/j.breast.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. Patients and methods The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. Results Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. Conclusions CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients. Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake. Within one year pain levels increase in both, CAM users as well as non-CAM users. In CAM users pain levels were higher at all time points than in non-CAM users. The greatest increase of pain levels was noted in the first six treatment months. CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.
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Affiliation(s)
- C C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - B Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; St. Theresien Hospital, Nuremberg, Germany
| | - A D Hartkopf
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - C-B Walter
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - A Fridman
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - W Malter
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany
| | - R Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - O Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - S Kuemmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - B Martin
- Tuttlingen Clinic, Tuttlingen, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - H Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | - C Wolf
- Ulm Medical Center, Ulm, Germany
| | - M P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - K Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - P Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - F Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Willer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Lindner
- Agaplesion Diakonie Clinic Hamburg, Hamburg, Germany
| | - H-C Kolberg
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - P Krabisch
- Department of Gynecology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - D Steinfeld-Birg
- Gynecologic Onocologic Practice Steinfeld-Birg, Augsburg, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - C Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - V Schulz
- Gynecologic Practice Abts+partner, Kiel, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - V Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - B Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany; Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - A Rody
- Department of Gynecology, Campus Lübeck, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - N Maass
- Department of Gynecology, Campus Kiel, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Griffin N, Dowling M. Vitamin D supplementation and clinical outcomes in cancer survivorship. ACTA ACUST UNITED AC 2019; 27:1121-1128. [PMID: 30346823 DOI: 10.12968/bjon.2018.27.19.1121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increasing evidence points to the role of vitamin D supplementation in cancer management. A comprehensive search of online databases was undertaken for all research studies relating to vitamin D supplementation in cancer survivorship published up to November 2017. Eighteen studies meeting the inclusion criteria were selected for this review, the majority of which involved supplementation in breast cancer. This review concludes that vitamin D supplementation plays an important role in disease-free survival in a number of cancers, particularly breast. In other cancers, the role of supplementation is less clear, and more research is required. More research is also required to investigate the most effective dose and duration of vitamin D supplementation to benefit cancer survivors.
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Affiliation(s)
- Niamh Griffin
- Graduate nurse, at time of writing this article final-year undergraduate student, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Maura Dowling
- Senior Lecturer, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Niravath P, Hilsenbeck SG, Wang T, Jiralerspong S, Nangia J, Pavlick A, Ademuyiwa F, Frith A, Ma C, Park H, Rigden C, Suresh R, Ellis M, Kent Osborne C, Rimawi MF. Randomized controlled trial of high-dose versus standard-dose vitamin D3 for prevention of aromatase inhibitor-induced arthralgia. Breast Cancer Res Treat 2019; 177:427-435. [PMID: 31218477 DOI: 10.1007/s10549-019-05319-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Half of hormone receptor-positive (HR+) breast cancer patients will develop joint pain, termed aromatase inhibitor-induced arthralgia (AIA), while taking aromatase inhibitor therapy. Though there is no universally accepted effective treatment for AIA, there has been some evidence to support high-dose vitamin D as a treatment. METHODS We randomized post-menopausal women who were beginning adjuvant AI therapy to receive standard-dose vitamin D3 (800 IU daily for 52 weeks), or high-dose vitamin D3 (50,000 IU weekly for 12 weeks, followed by 2000 IU daily for 40 weeks). The primary end point was development of AIA. The trial was designed to enroll 184 patients. This futility analysis was performed after 93 patients were enrolled. RESULTS The high-dose vitamin D regimen was effective in raising serum vitamin D levels, but there was no significant difference in development of AIA between the two arms. In the high-dose arm, 25 patients (54%) developed AIA, compared to 27 patients (57%) in the standard-dose arm. The planned futility analysis was positive; thus, the study was terminated. Neither baseline vitamin D nor 12-week vitamin D level was predictive of AIA development. CONCLUSION Although vitamin D levels were increased in the high-dose arm, there was no significant signal for benefit of high-dose vitamin D supplementation for AIA prevention in this unblinded trial. This study, along with several others, implies that vitamin D likely does not play a significant role in AIA for the majority of patients.
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Affiliation(s)
- Polly Niravath
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA.
| | - Susan G Hilsenbeck
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - Tao Wang
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - Sao Jiralerspong
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - Julie Nangia
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - Anne Pavlick
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | | | | | - Cynthia Ma
- Washington University, St. Louis, MO, USA
| | | | | | | | - Matthew Ellis
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - C Kent Osborne
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
| | - Mothaffar F Rimawi
- Baylor College of Medicine, 6445 Main Street, OPC 24-346, Houston, TX, 77030, USA
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14
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Assessment of early therapy discontinuation and health-related quality of life in breast cancer patients treated with aromatase inhibitors: B-ABLE cohort study. Breast Cancer Res Treat 2019; 177:53-60. [DOI: 10.1007/s10549-019-05289-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/18/2019] [Indexed: 11/25/2022]
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Pineda-Moncusí M, Garcia-Perez MA, Rial A, Casamayor G, Cos ML, Servitja S, Tusquets I, Diez-Perez A, Cano A, Garcia-Giralt N, Nogues X. Vitamin D levels in Mediterranean breast cancer patients compared with those in healthy women. Maturitas 2018; 116:83-88. [DOI: 10.1016/j.maturitas.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
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Peng N, Yu M, Yang G, Fu Q, Xu Y, Yu J, Liu Q, Li C, Xu W, Zhang Y, Ma C, Yang L, Yu R, Wang X. Effects of the Chinese medicine Yi Shen Jian Gu granules on aromatase inhibitor-associated musculoskeletal symptoms: A randomized, controlled clinical trial. Breast 2018; 37:18-27. [DOI: 10.1016/j.breast.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 11/30/2022] Open
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Nahm N, Mee S, Marx G. Efficacy of management strategies for aromatase inhibitor-induced arthralgia in breast cancer patients: a systematic review. Asia Pac J Clin Oncol 2018; 14:374-382. [PMID: 29380528 DOI: 10.1111/ajco.12845] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/12/2017] [Indexed: 01/22/2023]
Abstract
Aromatase inhibitors are the gold standard in the treatment of hormone receptor-positive breast cancer, but lead to an arthralgia syndrome which is implicated in 13-22% of noncompliance. This is the first systematic review of the efficacy of existing management strategies for this side effect. Eligible studies were retrieved from computer searches of Medline, Cochrane and Embase and the significant intervention groups were identified. The risk of bias of selected studies was evaluated and the relevant data items were extracted, summarized and analyzed. A total of 21 studies were discussed in this review representing 12 different interventions. While several trials had positive findings, the major methodological limitations of the studies meant that no definitive evidence could be found supporting any of the interventions. Future trials are needed which address the methodological problems identified in this review. Exercise holds promise for future research based on its proven benefit in breast cancer.
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Affiliation(s)
- Nicole Nahm
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
| | - Susie Mee
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
| | - Gavin Marx
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
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Niravath P, Chen B, Chapman JAW, Agarwal SK, Welschhans RL, Bongartz T, Kalari KR, Shepherd LE, Bartlett J, Pritchard K, Gelmon K, Hilsenbeck SG, Rimawi MF, Osborne CK, Goss PE, Ingle JN. Vitamin D Levels, Vitamin D Receptor Polymorphisms, and Inflammatory Cytokines in Aromatase Inhibitor-Induced Arthralgias: An Analysis of CCTG MA.27. Clin Breast Cancer 2017; 18:78-87. [PMID: 29128193 DOI: 10.1016/j.clbc.2017.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Approximately half of women taking aromatase inhibitor (AI) therapy develop AI-induced arthralgia (AIA), and many might discontinue AI therapy because of the pain. Using plasma samples from the MA.27 study, we assessed several factors potentially associated with AIA. PATIENTS AND METHODS MA.27 is a phase III adjuvant trial comparing 2 AIs, exemestane versus anastrozole. Within an 893-participant nested case-control AIA genome-wide association study, we nested a 72 AIA case-144 control assessment of vitamin D plasma concentrations, corrected for seasonal and geographic variation. We also examined 9 baseline inflammatory cytokines: interleukin (IL)-1β, IL-6, tumor necrosis factor-α, interferon (IFN)γ, IL-10, IL-12p70, IL-17, IL-23, and chemokine ligand (CCL)-20. Finally, we analyzed the multivariate effects of baseline factors: vitamin D level, previously identified musculoskeletal single nucleotide polymorphisms, age, body mass index, and vitamin D receptor (VDR) Fok-I variant genotype on AIA development. RESULTS Changes in vitamin D from baseline to 6 months were not significantly different between cases and controls. Elevated inflammatory cytokine levels were not associated with development of AIA. The multivariate model included no clinical factors associated with AIA. However, women with the VDR Fok-I variant genotype were more likely to have a lower IL-1β level (P = .0091) and less likely to develop AIA after 6 months of AI compared with those with the wild type VDR (P < .0001). CONCLUSION In this nested case-control correlative study, vitamin D levels were not significantly associated with development of AIA; however, patients with the Fok-I VDR variant genotype were more likely to have a significant reduction in IL-1β level, and less likely to develop AIA.
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Affiliation(s)
- Polly Niravath
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX.
| | - Bingshu Chen
- Department of Internal Medicine, Queens University Cancer Research Institute, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Judy-Anne W Chapman
- Department of Internal Medicine, Queens University Cancer Research Institute, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Sandeep K Agarwal
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | | | - Tim Bongartz
- Department of Internal Medicine, Vanderbilt University, Nashville, TN
| | | | - Lois E Shepherd
- Department of Internal Medicine, Queens University Cancer Research Institute, Kingston, Ontario, Canada
| | - John Bartlett
- Department of Internal Medicine, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Kathleen Pritchard
- Department of Internal Medicine, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Karen Gelmon
- Department of Internal Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Susan G Hilsenbeck
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Mothaffar F Rimawi
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - C Kent Osborne
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Paul E Goss
- Department of Internal Medicine, Harvard Medical School, Boston, MA
| | - James N Ingle
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Phytotherapy and Nutritional Supplements on Breast Cancer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7207983. [PMID: 28845434 PMCID: PMC5563402 DOI: 10.1155/2017/7207983] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/18/2017] [Indexed: 02/07/2023]
Abstract
Breast cancer is the most frequent type of nonskin malignancy among women worldwide. In general, conventional cancer treatment options (i.e., surgery, radiotherapy, chemotherapy, biological therapy, and hormone therapy) are not completely effective. Recurrence and other pathologic situations are still an issue in breast cancer patients due to side effects, toxicity of drugs in normal cells, and aggressive behaviour of the tumours. From this point of view, breast cancer therapy and adjuvant methods represent a promising and challenging field for researchers. In the last few years, the use of some types of complementary medicines by women with a history of breast cancer has significantly increased such as phytotherapeutic products and nutritional supplements. Despite this, the use of such approaches in oncologic processes may be problematic and patient's health risks can arise such as interference with the efficacy of standard cancer treatment. The present review gives an overview of the most usual phytotherapeutic products and nutritional supplements with application in breast cancer patients as adjuvant approach. Regardless of the contradictory results of scientific evidence, we demonstrated the need to perform additional investigation, mainly well-designed clinical trials in order to establish correlations and allow for further validated outcomes concerning the efficacy, safety, and clinical evidence-based recommendation of these products.
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Mohseni H, Hosseini SA, Amani R, Ekrami A, Ahmadzadeh A, Latifi SM. Circulating 25-Hydroxy Vitamin D Relative to Vitamin D Receptor Polymorphism after Vitamin D3 Supplementation in Breast Cancer Women: A Randomized, Double-Blind Controlled Clinical Trial. Asian Pac J Cancer Prev 2017; 18:1953-1959. [PMID: 28749628 PMCID: PMC5648404 DOI: 10.22034/apjcp.2017.18.7.1953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: The influence of vitamin D receptor (VDR) genetic variation on serum 25-hydroxyvitamin D levels
[25(OH)D] after vitamin D3 supplementation remains unclear. We aimed to investigate changes of 25(OH)D in a
randomized, double-blind, placebo-controlled clinical trial, according to VDR genotype, after provision of vitamin D3 to
breast cancer cases for a 2-month period. Methods: Participants were assigned to two treatment arms: placebo (n = 28)
and vitamin D3 supplementation (n =28). The supplementation group received 50,000 IU of vitamin D every week for 2
months. Blood samples were collected at baseline and after intervention to measure serum 25(OH)D3. Genotypes were
assessed for FokI, BsmI, ApaI, and TaqI polymorphisms. Results: After eight weeks supplementation, the intervention
group showed a significant increase in the serum concentration of 25 (OH)D3 (28±2.6 to 39±3.5; p=0.004). Subjects
were then classified into twelve subgroups according to different VDR genotypes. Subjects with ff/Ff, TT/Tt, and Bb
genotypes had significantly higher increases in serum 25(OH)D compared to those with FF, tt, and BB/bb genotypes
post-intervention. Serum vitamin D3 levels with the AA genotype were lower than with aa/ Aa. No differences were
found among other subgroups. Conclusion: Vitamin D3 supplementation increases serum 25(OH)D in women with
breast cancer. Serum vitamin D3 in TT/Tt, ff/Ff, and Bb carriers was more responsive to vitamin D supplementation
than in those with FF/ff and tt genotypes. Other subgroups might gain less from vitamin D3 supplementation.
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Affiliation(s)
- Houra Mohseni
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Dowling M, McDonagh B, Meade E. Arthralgia in Breast Cancer Survivors: An Integrative Review of Endocrine Therapy. Oncol Nurs Forum 2017. [DOI: 10.1188/17.337-349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roberts K, Rickett K, Greer R, Woodward N. Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early Breast cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 111:66-80. [DOI: 10.1016/j.critrevonc.2017.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/30/2016] [Accepted: 01/18/2017] [Indexed: 12/27/2022] Open
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Niravath P. Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done? CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Arul Vijaya Vani S, Ananthanarayanan P, Kadambari D, Harichandrakumar K, Niranjjan R, Nandeesha H. Effects of vitamin D and calcium supplementation on side effects profile in patients of breast cancer treated with letrozole. Clin Chim Acta 2016; 459:53-56. [DOI: 10.1016/j.cca.2016.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
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Jacot W, Firmin N, Roca L, Topart D, Gallet S, Durigova A, Mirr S, Abach L, Pouderoux S, D'Hondt V, Bleuse J, Lamy P, Romieu G. Impact of a tailored oral vitamin D supplementation regimen on serum 25-hydroxyvitamin D levels in early breast cancer patients: a randomized phase III study. Ann Oncol 2016; 27:1235-41. [DOI: 10.1093/annonc/mdw145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/17/2016] [Indexed: 11/14/2022] Open
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Liu X, Low SK, Boddy AV. The implications of genetic variation for the pharmacokinetics and pharmacodynamics of aromatase inhibitors. Expert Opin Drug Metab Toxicol 2016; 12:851-63. [PMID: 27253864 DOI: 10.1080/17425255.2016.1196189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Breast cancer is the most common female cancer and remains a serious public health concern worldwide. Third-generation aromatase inhibitors (AIs) are widely used in postmenopausal women with estrogen receptor positive breast cancer. However, there is marked interindividual variability in terms of the efficacy and incidence of adverse events following treatment with AIs. Pharmacogenetics has the potential to predict clinical outcomes based on patients' genetic information, paving the way towards personalized treatment. AREAS COVERED This article reviews pharmacogenetic studies of AIs, including pharmacokinetic and pharmacodynamic aspects, highlighting those studies where the efficacy and adverse events of AIs have been examined using both candidate gene and genome-wide approaches. EXPERT OPINION Pharmacogenetics is a promising approach to develop personalized medicine with AIs. However, the application of pharmacogenetics to predict therapeutic efficacy and adverse events in breast cancer patients is still far from implementation in routine clinical practice. Large, comprehensive, multicenter studies that simultaneously evaluate multiple genes and pathways, including rare variants, are warranted in order to produce reliable and informative results. The ultimate aim is to develop clinically-relevant guidelines for breast cancer therapy.
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Affiliation(s)
- Xiaoman Liu
- a Faculty of Pharmacy , University of Sydney , Sydney , Australia
| | - Siew-Kee Low
- a Faculty of Pharmacy , University of Sydney , Sydney , Australia
| | - Alan V Boddy
- a Faculty of Pharmacy , University of Sydney , Sydney , Australia
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Shapiro AC, Adlis SA, Robien K, Kirstein MN, Liang S, Richter SA, Lerner RE. Randomized, blinded trial of vitamin D3 for treating aromatase inhibitor-associated musculoskeletal symptoms (AIMSS). Breast Cancer Res Treat 2016; 155:501-12. [PMID: 26868123 PMCID: PMC5260816 DOI: 10.1007/s10549-016-3710-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 12/22/2022]
Abstract
The purpose of the study was to evaluate the efficacy and safety of vitamin D3 at 4000 IU/day as a treatment option for aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) when compared with the usual care dose of 600 IU D3. We conducted a single site randomized, double-blind, phase 3 clinical trial in women with AIMSS comparing change in symptoms, reproductive hormones and AI pharmacokinetics. Postmenopausal women ≥18 years with stages I-IIIA breast cancer, taking AI and experiencing AIMSS [breast cancer prevention trial symptom scale-musculoskeletal (BCPT-MS) subscale ≥1.5] were admitted. Following randomization, 116 patients had a run-in period of 1 month on 600 IU D3, then began the randomized assignment to either 600 IU D3 (n = 56) or 4000 IU D3 (n = 57) daily for 6 months. The primary endpoint was a change in AIMSS from baseline (after 1 month run-in) on the BCPT-MS (general MS pain, joint pain, muscle stiffness, range for each question: 0 = not at all to 4 = extremely). Groups had no statistically significant differences demographically or clinically. There were no discernable differences between the randomly allocated treatment groups at 6 months in measures of AIMSS, pharmacokinetics of anastrozole and letrozole, serum levels of reproductive hormones, or adverse events. We found no significant changes in AIMSS measures between women who took 4000 IU D3 daily compared with 600 IU D3. The 4000 IU D3 did not adversely affect reproductive hormone levels or the steady state pharmacokinetics of anastrozole or letrozole. In both groups, serum 25(OH)D remained in the recommended range for bone health (≥30 ng/mL) and safety (<50 ng/mL).
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Affiliation(s)
- Alice C Shapiro
- Oncology Research, Park Nicollet Institute and Frauenshuh Cancer Center, 3932 Louisiana Avenue S., Minneapolis, MN, 55416, USA.
| | - Susan A Adlis
- Oncology Research, Park Nicollet Institute and Frauenshuh Cancer Center, 3932 Louisiana Avenue S., Minneapolis, MN, 55416, USA
| | - Kim Robien
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mark N Kirstein
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Shuang Liang
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Sara A Richter
- Oncology Research, Park Nicollet Institute and Frauenshuh Cancer Center, 3932 Louisiana Avenue S., Minneapolis, MN, 55416, USA
| | - Rachel E Lerner
- Park Nicollet Frauenshuh Cancer Center, Minneapolis, MN, USA
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Gianni L, Arcangeli V, Tamburini E, Tassinari D. Omega-3 Fatty Acids for Aromatase Inhibitor–Induced Musculoskeletal Pain: Anything Other Than a Placebo Effect? J Clin Oncol 2015; 33:4311-2. [DOI: 10.1200/jco.2015.63.8726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Lombard JM, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes JF, Chirgwin J. Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options. Support Care Cancer 2015; 24:2139-2146. [PMID: 26556210 DOI: 10.1007/s00520-015-3001-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management. METHODS A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used. RESULTS Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category. CONCLUSION We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.
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Affiliation(s)
- Janine M Lombard
- Calvary Mater Newcastle, Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia. .,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.
| | - Nicholas Zdenkowski
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Kathy Wells
- Breast Cancer Network Australia, Newcastle, Vic, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Linda Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - John F Forbes
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Jacquie Chirgwin
- University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.,Monash University, Newcastle, Vic, Australia
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Servitja S, Martos T, Rodriguez Sanz M, Garcia-Giralt N, Prieto-Alhambra D, Garrigos L, Nogues X, Tusquets I. Skeletal adverse effects with aromatase inhibitors in early breast cancer: evidence to date and clinical guidance. Ther Adv Med Oncol 2015; 7:291-6. [PMID: 26327926 DOI: 10.1177/1758834015598536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aromatase inhibitors (AIs) are routinely used in the adjuvant treatment of women with hormone receptor-positive early breast cancer. Patients who receive AIs have an increased risk of bone loss and arthralgia compared with those treated with tamoxifen. In addition to the effects of AIs, the population of women with early breast cancer has a high prevalence of 25-hydroxyvitamin D (25(OH)D) insufficiency. In our experience 88% of patients had concentrations lower than 30 ng/ml. Vitamin D supplementation should be adapted to the baseline concentration. Another relevant finding in our research program was the close relationship between 25(OH)D levels and intensity of AI-related arthralgia (AIrA). A target concentration of 40 ng/ml 25(OH)D may prevent development of AIrA. We also demonstrate that AIrA is genetically determined: single nucleotide polymorphisms located in genes encoding key factors for the metabolism of estrogens and vitamin D (CYP17A1, VDR, and CYP27B1) are associated with self-reported arthralgia during AI therapy. We recommend establishing an individualized protocol of bone-health surveillance based on baseline and evolutionary clinical variables.
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Affiliation(s)
- Sonia Servitja
- Medical Oncology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Tamara Martos
- Medical Oncology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Maria Rodriguez Sanz
- Internal Medicine Department and URFOA-IMIM Department, Instituto de Salud Carlos III FEDER, Barcelona, Spain
| | - Natalia Garcia-Giralt
- Internal Medicine Department and URFOA-IMIM Department, Instituto de Salud Carlos III FEDER, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Internal Medicine Department and URFOA-IMIM Department, Instituto de Salud Carlos III FEDER, Barcelona, Spain, and Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | - Laia Garrigos
- Medical Oncology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Xavier Nogues
- Internal Medicine Department and URFOA-IMIM Department, Instituto de Salud Carlos III FEDER, Barcelona, Spain
| | - Ignasi Tusquets
- Medical Oncology Department, Parc de Salut Mar, Cancer Research Program, Hospital del Mar Medical Research Institute, Passeig Maritim 25, 08003 Barcelona, Spain
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Singer O, Cigler T, Moore AB, Levine AB, Do HT, Mandl LA. Hypovitaminosis D is a Predictor of Aromatase Inhibitor Musculoskeletal Symptoms. Breast J 2014; 20:174-9. [DOI: 10.1111/tbj.12227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ora Singer
- Division of Rheumatology; Department of Medicine; Georgia Health Sciences University; Augusta Georgia
| | - Tessa Cigler
- Division of Oncology; Department of Medicine; Weill Cornell Medical Center; New York New York
| | - Anne B. Moore
- Division of Oncology; Department of Medicine; Weill Cornell Medical Center; New York New York
| | - Alana B. Levine
- Division of Rheumatology; Department of Medicine; Hospital for Special Surgery; New York New York
| | - Huong T. Do
- Department of Biostatistics; Hospital for Special Surgery; New York New York
| | - Lisa A. Mandl
- Division of Rheumatology; Department of Medicine; Hospital for Special Surgery; New York New York
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[Vitamin D and breast cancer: physiopathology, biological and clinical implications]. Bull Cancer 2013; 101:266-82. [PMID: 24103818 DOI: 10.1684/bdc.2013.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a recent increase in interest of vitamin D and breast cancer, facing the number of publications on the subject. This increase have several reasons, on the one hand, vitamin D deficiency is more and more prevalent and, on the other hand, there are new data that highlights the extra-bone effects of vitamin D, especially in breast cancer, the vitamin D is involved in the breast cancer risk factor, the prognosis, and the interaction with breast cancer treatments. This combination between vitamin D deficiency and breast cancer is extremely usual, and combined with all cancer clinical parameters: the incidence, the tumour biology, the clinical presentation, the prognosis, and the antineoplastic treatment tolerance. This vitamin D deficiency is increased after adjuvant cancer treatments. And yet, this problem increases bone metabolism disruptions in breast cancer patients, inducing osteoporotic risk at long time, even though this population is curable. This problem is therefore serious in the adjuvant breast cancer treatment. Unfortunately, in this population, the current recommendations are clearly insufficient, and the current randomized clinical trial results would contribute to define the best way to correct the vitamin D deficiency, quickly and secure.
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Teleni L, Baker J, Koczwara B, Kimlin MG, Walpole E, Tsai K, Isenring EA. Clinical outcomes of vitamin D deficiency and supplementation in cancer patients. Nutr Rev 2013; 71:611-21. [DOI: 10.1111/nure.12047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
| | - Jacqueline Baker
- School of Human Movement Studies; University of Queensland; Brisbane; Queensland; Australia
| | - Bogda Koczwara
- Department of Medical Oncology; Flinders Medical Centre; Adelaide; South Australia; Australia
| | - Michael G Kimlin
- NHMRC Centre for Research Excellence in Sun and Health and AusSun Research Lab; Queensland University of Technology; Brisbane; Australia
| | - Euan Walpole
- Division of Cancer Services; Princess Alexandra Hospital; Brisbane; Queensland; Australia
| | - Kathy Tsai
- School of Human Movement Studies; University of Queensland; Brisbane; Queensland; Australia
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Garcia-Giralt N, Rodríguez-Sanz M, Prieto-Alhambra D, Servitja S, Torres-del Pliego E, Balcells S, Albanell J, Grinberg D, Diez-Perez A, Tusquets I, Nogués X. Genetic determinants of aromatase inhibitor-related arthralgia: the B-ABLE cohort study. Breast Cancer Res Treat 2013; 140:385-95. [DOI: 10.1007/s10549-013-2638-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Gröber U, Spitz J, Reichrath J, Kisters K, Holick MF. Vitamin D: Update 2013: From rickets prophylaxis to general preventive healthcare. DERMATO-ENDOCRINOLOGY 2013; 5:331-47. [PMID: 24516687 PMCID: PMC3908963 DOI: 10.4161/derm.26738] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 02/06/2023]
Abstract
Vitamin D has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, infectious diseases and cardiovascular disease. The recent data on vitamin D from experimental, ecological, case-control, retrospective and prospective observational studies, as well as smaller intervention studies, are significant and confirm the sunshine vitamin's essential role in a variety of physiological and preventative functions. The results of these studies justify the recommendation to improve the general vitamin D status in children and adults by means of a healthy approach to sunlight exposure, consumption of foods containing vitamin D and supplementation with vitamin D preparations. In general, closer attention should therefore be paid to vitamin D deficiency in medical and pharmaceutical practice than has been the case hitherto.
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Affiliation(s)
- Uwe Gröber
- Academy for Micronutrient Medicine; Essen, Germany
| | - Jörg Spitz
- Institute for Medical Information and Prevention; Wiesbaden, Germany
| | - Jörg Reichrath
- Universitätsklinikum des Saarlandes; Homburg/Saar, Germany
| | - Klaus Kisters
- Academy for Micronutrient Medicine; Essen, Germany
- St. Anna Hospital, Medical Clinic I; Herne, Germany
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Castel LD, Hartmann KE, Mayer IA, Saville BR, Alvarez J, Boomershine CS, Abramson VG, Chakravarthy AB, Friedman DL, Cella DF. Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort. Cancer 2013; 119:2375-82. [PMID: 23575918 DOI: 10.1002/cncr.28016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/03/2013] [Accepted: 01/31/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND More than 80,000 postmenopausal breast cancer patients in the United States each year are estimated to begin a 5-year course of aromatase inhibitors (AIs) to prevent recurrence. AI-related arthralgia (joint pain and/or stiffness) may contribute to nonadherence, but longitudinal data are needed on arthralgia risk factors, trajectories, and background in postmenopause. This study sought to describe 1-year arthralgia trajectories and baseline covariates among patients with AI and a postmenopausal comparison group. METHODS Patients initiating AIs (n = 91) were surveyed at the time of AI initiation and at 6 repeated assessments over 1 year. A comparison group of postmenopausal women without breast cancer (n = 177) completed concomitantly timed surveys. Numeric rating scales (0-10) were used to measure pain in 8 joint pair groups (bilateral fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes). Poisson regression models were used to analyze arthralgia trajectories and risk factors. RESULTS By week 6, the AI-initiating group had more severe arthralgia than did the comparison group (ratio of means = 1.8, 95% confidence interval = 1.24-2.7, P = .002), adjusting for baseline characteristics. Arthralgia then worsened further over 1 year in the AI group. Menopausal symptom severity and existing joint-related comorbidity at baseline among women initiating AI were associated with more severe arthralgia over time. CONCLUSIONS Patients initiating AI should be told about the timing of arthralgia over the first year of therapy, and advised that it does not appear to resolve over the course of a year. Menopausal symptoms and joint-related comorbidity at AI initiation can help identify patients at risk for developing AI-related arthralgia.
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Affiliation(s)
- Liana D Castel
- Vanderbilt University Medical Center, Nashville, Tennessee 37203-1738, USA.
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Greenlee H, Crew KD, Shao T, Kranwinkel G, Kalinsky K, Maurer M, Brafman L, Insel B, Tsai WY, Hershman DL. Phase II study of glucosamine with chondroitin on aromatase inhibitor-associated joint symptoms in women with breast cancer. Support Care Cancer 2013; 21:1077-87. [PMID: 23111941 PMCID: PMC3810608 DOI: 10.1007/s00520-012-1628-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 10/09/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE Many women with hormone receptor-positive breast cancer discontinue effective aromatase inhibitor (AI) treatment due to joint symptoms. METHODS We conducted a single-arm, open-label, phase II study evaluating glucosamine-sulfate (1,500 mg/day) + chondroitin-sulfate (1,200 mg/day) for 24 weeks to treat joint pain/stiffness in postmenopausal women with early stage breast cancer who developed moderate-to-severe joint pain after initiating AIs. The primary endpoint was improvement in pain/stiffness at week 24 assessed by the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria. Secondary endpoints assessed changes in pain, stiffness, and function using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index for hips/knees and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH) for hands/wrists. The Brief Pain Inventory (BPI) assessed pain interference, severity, and worst pain. RESULTS Of 53 patients enrolled, 39 were evaluable at week 24. From baseline to week 24, 46 % of patients improved according to OMERACT-OARSI criteria. At week 24, there were improvements (all P < 0.05) in pain and function as assessed by WOMAC and M-SACRAH, and in pain interference, severity, and worst pain as assessed by BPI. Estradiol levels did not change from baseline. The most commonly reported side effects were headache (28 %), dyspepsia (15 %), and nausea (17 %). CONCLUSIONS In this single-arm study, 24 weeks of glucosamine/chondroitin resulted in moderate improvements in AI-induced arthralgias, with minimal side effects, and no changes in estradiol levels. These results suggest a need to evaluate efficacy in a placebo-controlled trial.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Katherine D. Crew
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Theresa Shao
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Grace Kranwinkel
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Kevin Kalinsky
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Matthew Maurer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Lois Brafman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Beverly Insel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wei Yann Tsai
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA. Columbia University, 161 Fort Washington Avenue, Room 1068, New York, NY 10032, USA
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Crew KD. Vitamin d: are we ready to supplement for breast cancer prevention and treatment? ISRN ONCOLOGY 2013; 2013:483687. [PMID: 23533810 PMCID: PMC3600307 DOI: 10.1155/2013/483687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/29/2013] [Indexed: 12/31/2022]
Abstract
Vitamin D deficiency is a potentially modifiable risk factor that may be targeted for breast cancer prevention and treatment. Preclinical studies support various antitumor effects of vitamin D in breast cancer. Numerous observational studies have reported an inverse association between vitamin D status, including circulating 25-hydroxyvitamin D (25(OH)D) levels, and breast cancer risk. The relationship between vitamin D and mammographic density, a strong predictor of breast cancer risk, remains unclear. Studies analyzing the link between genetic polymorphisms in vitamin D pathway genes and breast cancer incidence and prognosis have yielded inconsistent results. Vitamin D deficiency among breast cancer patients has been associated with poorer clinical outcomes and increased mortality. Despite a number of clinical trials of vitamin D supplementation, the efficacy, optimal dosage of vitamin D, and target blood level of 25(OH)D for breast cancer prevention have yet to be determined. Even with substantial literature on vitamin D and breast cancer, future studies need to focus on gaining a better understanding of the biologic effects of vitamin D in breast tissue. Despite compelling data from experimental and observational studies, there is still insufficient data from clinical trials to make recommendations for vitamin D supplementation for breast cancer prevention or treatment.
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Affiliation(s)
- Katherine D. Crew
- Department of Medicine, Division of Hematology/Oncology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
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Gröber U, Mücke R, Adamietz I, Holzhauer P, Kisters K, Büntzel J, Micke O. Komplementärer Einsatz von Antioxidanzien und Mikronährstoffen in der Onkologie. DER ONKOLOGE 2013. [DOI: 10.1007/s00761-012-2385-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Rizzoli R, Body JJ, DeCensi A, Reginster JY, Piscitelli P, Brandi ML. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporos Int 2012; 23:2567-76. [PMID: 22270857 DOI: 10.1007/s00198-011-1870-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED Aromatase inhibitors (AIs) are widely used in women with breast cancer, but they are known to increase bone loss and risk of fractures. Based on available evidence and recommendations, an ESCEO working group proposes specific guidance for the prevention of AIs-induced bone loss and fragility fractures. INTRODUCTION Aromatase inhibitors (AIs) are now the standard treatment for hormone receptor-positive breast cancer. However, deleterious effects of AIs on bone health have been reported. An ESCEO working group proposes guidance for the prevention of bone loss and fragility fractures in post-menopausal women with breast cancer receiving AIs. METHODS A panel of experts addressed the issue of skeletal effects of AIs and effectiveness of antifracture therapies for the prevention of AI-induced bone loss and fractures. Recommendations by national and international organizations, and experts' opinions on this topic were evaluated. RESULTS All aromatase inhibitors are associated with negative effects on the skeleton, resulting in bone loss and increased risk of fragility fractures. Current guidelines suggest approaches that differ both in terms of drugs proposed for fracture prevention and duration of treatment. CONCLUSION The ESCEO working group recommends that all AI-treated women should be evaluated for fracture risk. Besides general recommendations, zoledronic acid 4 mg i.v. every 6 months, denosumab s.c., or possibly oral bisphosphonates should be administered for the entire period of AI treatment to all osteoporotic women (T-score hip/spine <-2.5 or ≥ 1 prevalent fragility fracture), to women aged ≥ 75 irrespective of BMD, and to patients with T-score <-1.5 + ≥ 1 clinical risk factor or T-score <-1.0 + ≥ 2 clinical risk factors. Alternatively, therapy could be considered in patients with a FRAX-determined 10-year hip fracture probability ≥ 3%.
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Affiliation(s)
- R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Abstract
In the past, interactions between drugs and vitamin D have received only little or no attention in the health care practices. However, since more and more drugs are used for the treatment of patients, this topic is increasingly relevant. Several drugs can interfere with the vitamin D and bone metabolism. Drugs that activate the pregnane X receptor can disrupt vitamin D metabolism and vitamin D function. Beside this, the medication oriented supplementation of vitamin D can ameliorate the pharmacologic action of some drugs, such as bisphosphonates, cytostatics and statins.
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Park SH, Knobf MT, Sutton KM. Etiology, assessment, and management of aromatase inhibitor-related musculoskeletal symptoms. Clin J Oncol Nurs 2012; 16:260-6. [PMID: 22641317 DOI: 10.1188/12.cjon.260-266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aromatase inhibitors (AIs) are recommended as adjuvant endocrine therapy for postmenopausal women with hormone-responsive breast cancer. With the widespread use of AI adjuvant endocrine therapy, a significant profile of musculoskeletal symptoms has emerged. Moderate to severe musculoskeletal symptoms have led some women to discontinue therapy, compromising the survival benefit. The etiology of AI-related musculoskeletal symptoms is poorly understood, which challenges development of effective management strategies. The purpose of this article is to describe AI-related musculoskeletal symptoms, review possible causes, provide assessment guidelines, and recommend management strategies based on the best available evidence. Little evidence exists for effective management strategies of AI-related musculoskeletal symptoms, and randomized clinical trials are needed to establish effective interventions. A thorough musculoskeletal assessment can help guide clinical decision making for the best individual management approach. Providers need to manage symptoms with the best available evidence to minimize symptom distress and maximize adherence to AI therapy.
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Affiliation(s)
- So-Hyun Park
- School of Nursing, Yale University, New Haven, CT, USA.
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McCowan C, Thompson AM. The importance of nonpharmacogenetic factors in endocrine therapy. Pharmacogenomics 2012; 13:721-8. [PMID: 22515614 DOI: 10.2217/pgs.12.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nonpharmacogenetic factors may play a key role in the success of oral endocrine therapy for breast cancer. Adherence, defined as following medical advice as well as persistence and duration of use for patients prescribed endocrine therapy, may impact significantly on recurrence and survival. Side effects from tamoxifen or aromatase inhibitors may lead to patients stopping or switching therapy, while comorbidities, consequent coprescribing and patient perceptions may also influence outcomes. Interventions to improve adherence and persistence are required and could have as great an effect on survival as applying pharmacogenetic principles to the endocrine management of breast cancer.
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Affiliation(s)
- Colin McCowan
- Dundee Cancer Centre, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
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Zhang C, Lv GQ, Li JP, Zhou P. Comments on adolescent intakes of vitamin D and calcium and incidence of proliferative benign breast disease. Breast Cancer Res Treat 2012; 134:1347-8. [DOI: 10.1007/s10549-012-2153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
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Lintermans A, Brouckaert O, Neven P. Managing the side effects of oral aromatase inhibitors. BREAST CANCER MANAGEMENT 2012. [DOI: 10.2217/bmt.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aromatase inhibitors (AIs) are increasingly being used to treat postmenopausal estrogen receptor-positive breast cancer. In the short term they enhance or induce menopausal symptoms that compromise AI adherence, while in the long-term they adversely affect bone and probably also cardiovascular health, although this is mainly when compared to tamoxifen, which is cardioprotective. The distinct decrease in estrogen levels following AI administration is believed to be the main reason for the emergence of these side effects, although exact mechanisms remain to be elucidated. As such, management strategies to meet these AI-induced toxicities are still mainly symptomatic. In this review, current treatment options and promising new modalities under research will be discussed.
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Affiliation(s)
- Anneleen Lintermans
- Department of Gynecologic Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Olivier Brouckaert
- Department of Gynecologic Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Multidisciplinary Breast Centre, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Patrick Neven
- Department of Gynecologic Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Hatse S, Lambrechts D, Verstuyf A, Smeets A, Brouwers B, Vandorpe T, Brouckaert O, Peuteman G, Laenen A, Verlinden L, Kriebitzsch C, Dieudonné AS, Paridaens R, Neven P, Christiaens MR, Bouillon R, Wildiers H. Vitamin D status at breast cancer diagnosis: correlation with tumor characteristics, disease outcome, and genetic determinants of vitamin D insufficiency. Carcinogenesis 2012; 33:1319-26. [PMID: 22623648 DOI: 10.1093/carcin/bgs187] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We correlated serum 25-hydroxyvitamin D(3) (25OHD) levels with tumor characteristics and clinical disease outcome in breast cancer patients and assessed the impact of genetic determinants of vitamin D insufficiency. We collected serum from 1800 early breast cancer patients at diagnosis, measured 25OHD by radioimmunoassay (RIA), and determined genetic variants in vitamin D-related genes by Sequenom. Multivariable regression models were used to correlate 25OHD levels with tumor characteristics. Cox proportional hazard models were used to assess overall survival (OS), disease-specific survival (DSS), and disease-free interval (DFI). Lower 25OHD serum levels significantly correlated with larger tumor size at diagnosis (P = 0.0063) but not with lymph node invasion, receptor status, or tumor grade. Genetic variants in 25-hydroxylase (CYP2R1) and vitamin D-binding (DBP) protein significantly determined serum 25OHD levels but did not affect the observed association between serum 25OHD and tumor size. High serum 25OHD (>30 ng/mL) at diagnosis significantly correlated with improved OS (P = 0.0101) and DSS (P = 0.0192) and additionally had a modest effect on DFI, which only became apparent after at least 3 years of follow-up. When considering menopausal status, serum 25OHD had a strong impact on breast cancer-specific outcome in postmenopausal patients [hazards ratios for 25OHD >30 ng/mL versus ≤30 ng/mL were 0.15 (P = 0.0097) and 0.43 (P = 0.0172) for DSS and DFI, respectively], whereas no association could be demonstrated in premenopausal patients. In conclusion, high vitamin D levels at early breast cancer diagnosis correlate with lower tumor size and better OS, and improve breast cancer-specific outcome, especially in postmenopausal patients.
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Affiliation(s)
- Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, University Hospitals Leuven, Leuven Cancer Institute, Belgium
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Winters-Stone KM, Schwartz AL, Hayes SC, Fabian CJ, Campbell KL. A prospective model of care for breast cancer rehabilitation: Bone health and arthralgias. Cancer 2012; 118:2288-99. [DOI: 10.1002/cncr.27465] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE To assess the association of serum 25-hydroxy-calciferol levels with pain and low back function in patients with failed back surgery syndrome. METHODS Records of 6 men and 3 women aged 25 to 54 (mean, 39.2) years who had failed back surgery syndrome after pedicular screw and rod instrumentation for lower lumbar degenerative diseases were reviewed. They had moderate-to-severe pain (visual analogue scale [VAS] score of >6) and low back function disability (Japanese Orthopaedic Association [JOA] back score of <10). In all patients, the serum 25-hydroxy-calciferol level was <30 ng/ ml, indicating vitamin D deficiency. Vitamin D2 (20 000 IU per day) was given for 10 days, and vitamin D3 (600 IU per day) was given for maintenance. Patients were followed up at months 3 and 6. Three men and 4 women aged 27 to 55 (mean, 41.3) years who were age- and disease-matched but achieved good outcomes (VAS score of 0-1 and mean JOA low back score of 14.7) were used as indirect referents. All 7 matched patients except one had a normal serum 25-hydroxy-calciferol level (mean, 40.6 ng/ml). RESULTS In the 9 patients with failed back surgery syndrome, the mean duration of chronic pain was 2.6 years; the mean VAS score for pain was 7.7; the mean JOA low back score was 7.6; the mean number of reoperations was 2.2; and the mean serum 25-hydroxy-calciferol level was 17.0 ng/ml. Two male patients had grade-IV motor weakness and decreased sensory function based on the pin prick test. One patient had a history of prolonged (>3 months) antibiotic use after primary surgery, but had no evidence of infection. Six months after vitamin D2 and vitamin D3 supplementation, the mean serum 25-hydroxy-calciferol level improved significantly (17.0 vs. 42.5 ng/ml), as did the mean pain score (7.7 vs. 4.2) and mean JOA back score (7.6 vs. 11.1). Seven of the patients had a pain score of <6 and a JOA back score of >10, the remaining 2 patients had neurological deficits and only slight improvement. CONCLUSION Vitamin D supplementation may be used as an adjuvant treatment for patients with failed back surgery syndrome.
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Affiliation(s)
- Saranatra Waikakul
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Bryce J, Bauer M, Hadji P. Managing arthralgia in a postmenopausal woman taking an aromatase inhibitor for hormonesensitive early breast cancer: a case study. Cancer Manag Res 2012; 4:105-11. [PMID: 22570564 PMCID: PMC3345876 DOI: 10.2147/cmar.s29448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In order to reduce the risk of recurrence, adjuvant treatment with an aromatase inhibitor (AI) is recommended for postmenopausal women following surgery for hormone receptor-positive breast cancer. AIs are associated with improved disease-free survival compared with tamoxifen. The adverse events associated with AIs resemble those of menopause, such as bone density loss and musculoskeletal symptoms. PURPOSE We examine the case of a postmenopausal woman who was prescribed anastrozole, a nonsteroidal AI, as adjuvant therapy following surgery for estrogen and progesterone receptor-positive (ER and PgR+) breast cancer. METHODS AND SAMPLE A 58-year-old postmenopausal woman diagnosed with ER and PgR+ breast cancer was prescribed anastrozole as adjuvant therapy following a right-inferior quadrantectomy. After experiencing joint pain and stiffness, she was prescribed paracetamol and a topical nonsteroidal anti-inflammatory drug. She was also counseled on nonpharmacological interventions. However, she continued to experience symptoms, and reported that she was not taking anastrozole regularly. RESULTS The case study patient ultimately found relief by switching to letrozole, another aromatase inhibitor. This approach is supported by recent studies examining the benefits of switching strategies between aromatase inhibitors in order to relieve symptoms of arthralgia/myalgia. CONCLUSIONS Both adherence and strategies for managing aromatase inhibitor-associated arthralgia are key to deriving maximal clinical benefit from AI therapy. Switching from one aromatase inhibitor to another may provide a viable option in managing adverse events and enhancing adherence to medication.
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Affiliation(s)
- Jane Bryce
- National Cancer Institute, Naples, Italy
| | | | - Peyman Hadji
- Philipps University of Marburg, Marburg, Germany
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Peppone LJ, Rickles AS, Janelsins MC, Insalaco MR, Skinner KA. The association between breast cancer prognostic indicators and serum 25-OH vitamin D levels. Ann Surg Oncol 2012; 19:2590-9. [PMID: 22446898 DOI: 10.1245/s10434-012-2297-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies show that women with low vitamin D levels have an increased risk of breast cancer (BC) incidence and mortality, but there is a lack of research examining vitamin D levels and prognostic variables in BC patients. The aim of this study is to examine 25-OH vitamin D levels between BC cases and controls and by prognostic indicators among BC cases. METHODS 25-OH vitamin D levels were collected from 194 women who underwent BC surgery and 194 cancer-free (CF) controls at the University of Rochester between January 2009 and October 2010. Mean 25-OH vitamin D levels and odds ratios (OR) were calculated by case/control status for the overall cohort and by prognostic indicators (invasiveness, ER status, triple-negative status, Oncotype DX score, molecular phenotype) for BC cases. RESULTS BC cases had significantly lower 25-OH vitamin D levels than CF controls (BC: 32.7 ng/mL vs. CF: 37.4 ng/mL; P = .02). In case-series analyses, women with suboptimal 25-OH vitamin D concentrations (<32 ng/mL) had significantly higher odds of having ER- (OR = 2.59, 95% confidence interval [95% CI] = 1.08-6.23) and triple-negative cancer (OR = 3.15, 95% CI = 1.05-9.49) than those with optimal 25-OH D concentrations. Women with basal-like phenotype had lower 25-OH vitamin D levels than women luminal A phenotype (basal-like: 24.2 ng/mL vs. luminal A: 32.8 ng/mL; P = 0.04). CONCLUSIONS BC patients with a more aggressive molecular phenotype (basal-like) and worse prognostic indicators (ER- and triple-negative) had lower mean 25-OH vitamin D levels. Further research is needed to elucidate the biological relationship between vitamin D and BC progression.
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Affiliation(s)
- Luke J Peppone
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, NY, USA.
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