Nonsteroidal antiinflammatory drugs and progestins synergistically enhance cell death in ovarian epithelial cells

Nonsteroidal anti-inflammatory drug use and breast cancer risk in a European prospective cohort study

Experimental studies have shown a protective effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on breast cancer development. However, results from epidemiological cohort studies are less consistent. Our objective was to assess the association between NSAID use and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Self-reported information on NSAID use at baseline has been collected in five EPIC countries. Multivariable Cox regression models were used to estimate hazard ratios for the association of NSAID use with breast cancer incidence with adjustment for potential confounders. We also assessed effect modification by breast cancer risk factors and examined the associations within specific breast cancer subtypes. Among the 140,981 women included in the analysis, 7% were regularly using NSAIDs at baseline. During a median follow-up time period of 13 years, 7,379 incident breast cancer cases were diagnosed (816 in situ and 6,563 invasive). There were no statistically significant associations between NSAID use and breast cancer risk, overall and by subtypes. However, a statistically significant interaction was observed for invasive cases between NSAID use and ever use of menopausal hormonal therapy (MHT) among postmenopausal women [MHT users: HRNSAID use  = 0.84 (0.73-0.96); non MHT users: HRNSAID use  = 1.08 (0.93-1.25); pinteraction  = 0.05]. Our results indicate potential effect modification of MHT use on the association between use of NSAIDs and breast cancer risk which deserves in-depth investigation in studies with accurate data on both NSAID and MHT use.

Progestins inhibit calcitriol-induced CYP24A1 and synergistically inhibit ovarian cancer cell viability: An opportunity for chemoprevention

OBJECTIVES

Previously we have shown in endometrial cells that progesterone (P4) and calcitriol (CAL, 1,25(OH)2D3) synergistically promote apoptosis and that progestins induce expression of the vitamin D receptor. In the current study we examined the progestin/vitamin D combination in ovarian cells and searched for other progestin-related effects on vitamin D metabolism that may underlie the novel interaction between progestins and vitamin D, including whether progestins inhibit CYP24A1, the enzyme that renders CAL inactive.

METHODS

We investigated the impact of P4 on CAL-induced CYP24A1 expression in cancer cell lines expressing progesterone receptors (PRs), [OVCAR-5, OVCAR-3-PGR (PR-transfected OVCAR-3 ovarian line), and T47D-WT, T47D-A and T47D-B (breast lines expressing PRs or individual PR isoforms)] or lines that do not express PRs (OVCAR-3 and T47D-Y). We examined CYP24A1 expression using RT-PCR and western blotting, and apoptosis by TUNEL. We also investigated P4 inhibition of Cyp24a1 in ovaries from CAL-treated mice.

RESULTS

CAL treatment induced CYP24A1 expression. When co-treated with P4, cell lines expressing PRs showed marked inhibition of CYP24A1 expression (p<0.001), along with increased apoptosis (p<0.01); cells not expressing PRs did not. Mouse ovaries showed a significant reduction in CAL-induced Cyp24a1 mRNA (p<0.001) and protein (p<0.01) in response to P4.

CONCLUSIONS

We show for the first time that progestins and vitamin D synergistically reduce cell viability and induce apoptosis in ovarian cells and that progestins PR-dependently inhibit CAL-induced CYP24A1, thus extending CAL activity. The combination of progestins and vitamin D deserves further consideration as a strategy for inhibiting ovarian carcinogenesis.

The role of reproductive hormones in epithelial ovarian carcinogenesis

Epithelial ovarian cancer comprises ∼85% of all ovarian cancer cases. Despite acceptance regarding the influence of reproductive hormones on ovarian cancer risk and considerable advances in the understanding of epithelial ovarian carcinogenesis on a molecular level, complete understanding of the biologic processes underlying malignant transformation of ovarian surface epithelium is lacking. Various hypotheses have been proposed over the past several decades to explain the etiology of the disease. The role of reproductive hormones in epithelial ovarian carcinogenesis remains a key topic of research. Primary questions in the field of ovarian cancer biology center on its developmental cell of origin, the positive and negative effects of each class of hormones on ovarian cancer initiation and progression, and the role of the immune system in the ovarian cancer microenvironment. The development of the female reproductive tract is dictated by the hormonal milieu during embryogenesis. Intensive research efforts have revealed that ovarian cancer is a heterogenous disease that may develop from multiple extra-ovarian tissues, including both Müllerian (fallopian tubes, endometrium) and non-Müllerian structures (gastrointestinal tissue), contributing to its heterogeneity and distinct histologic subtypes. The mechanism underlying ovarian localization, however, remains unclear. Here, we discuss the role of reproductive hormones in influencing the immune system and tipping the balance against or in favor of developing ovarian cancer. We comment on animal models that are critical for experimentally validating existing hypotheses in key areas of endocrine research and useful for preclinical drug development. Finally, we address emerging therapeutic trends directed against ovarian cancer.

Risk of Endometrial Cancer in Women With Pelvic Inflammatory Disease: A Nationwide Population-Based Retrospective Cohort Study

To investigate the association between pelvic inflammatory disease (PID) and endometrial cancer (EC).We conducted a nationwide population-based retrospective cohort study, and data were obtained from the National Health Insurance Research Database. We defined 41,065 patients with PID as the PID cohort and 82,130 randomly selected patients as the control cohort through frequency matching by age and index year. PID and EC were diagnosed in accordance with the International Classification of Diseases, Ninth Revision, and Clinical Modification. Cox proportional hazards regression and Kaplan-Meier method were used in the analysis.Incidence rates of 16.1 and 9.6 per 100,000 person-years and mean follow-up durations of 4.84 and 6.63 years were observed in the PID and non-PID cohorts, respectively. After adjusting for potential risk factors, the PID cohort had a 1.79-fold higher risk of developing EC than the non-PID cohort. The incidence of EC increased with age, particularly for those aged >50 years (HR=2.45, 95% CI=1.29-4.65). Higher EC risk was also observed in the PID cohort with hypertension than in the non-PID cohort.The results of this large-scale population-based study showed an increased risk of EC in PID patients, particularly in older patients or those with hypertension. Future large-scale clinical trials are warranted to clarify the function of medication in PID-related EC progression.

Hormone response in ovarian cancer: time to reconsider as a clinical target?

Ovarian cancer is the sixth most common cancer worldwide among women in developed countries and the most lethal of all gynecologic malignancies. There is a critical need for the introduction of targeted therapies to improve outcome. Epidemiological evidence suggests a critical role for steroid hormones in ovarian tumorigenesis. There is also increasing evidence from in vitro studies that estrogen, progestin, and androgen regulate proliferation and invasion of epithelial ovarian cancer cells. Limited clinical trials have shown modest response rates; however, they have consistently identified a small subset of patients that respond very well to endocrine therapy with few side effects. We propose that it is timely to perform additional well-designed trials that should include biomarkers of response.

Hormone response in ovarian cancer: time to reconsider as a clinical target?

Ovarian cancer is the sixth most common cancer worldwide among women in developed countries and the most lethal of all gynecologic malignancies. There is a critical need for the introduction of targeted therapies to improve outcome. Epidemiological evidence suggests a critical role for steroid hormones in ovarian tumorigenesis. There is also increasing evidence from in vitro studies that estrogen, progestin, and androgen regulate proliferation and invasion of epithelial ovarian cancer cells. Limited clinical trials have shown modest response rates; however, they have consistently identified a small subset of patients that respond very well to endocrine therapy with few side effects. We propose that it is timely to perform additional well-designed trials that should include biomarkers of response.

Use of nonsteroidal anti-inflammatory drugs and risk of ovarian and endometrial cancer: the Multiethnic Cohort

BACKGROUND

Chronic inflammation may play an etiologic role in ovarian and endometrial cancer, and it is hypothesized that nonsteroidal anti-inflammatory drugs (NSAID) decrease the risk of developing these malignancies. No prospective study with a large multiethnic population has explored this hypothesis.

METHODS

We investigated whether NSAID use was associated with risks of ovarian and endometrial cancer in the Multiethnic Cohort Study. Medication use of at least twice a week for ≥1 month was assessed at baseline. Multivariable relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models.

RESULTS

During 13.3 years of follow-up, 275 ovarian and 620 endometrial incident cases were identified among approximately 64,000 women included in this analysis (16.5% African Americans, 30.8% Japanese, 7.7% Native Hawaiians, 18.9%, Latinas, and 26.0% whites). The RR (95% CI) for ovarian cancer associated with aspirin, non-aspirin NSAIDs, and acetaminophen were 0.87 (0.68-1.14), 0.97 (0.74-1.26), and 0.86 (0.67-1.12), respectively. The RR (95% CI) for endometrial cancer associated with aspirin, non-aspirin NSAIDs, and acetaminophen were 0.93 (0.79-1.10), 0.88 (0.74-1.05), and 0.96 (0.81-1.13), respectively. No heterogeneity across ethnic groups (P ≥ 0.29) or dose-response relation with increased duration of use (P(trend) ≥ 0.16) was observed. The results did not differ by tumor histology.

CONCLUSIONS

We found no compelling evidence to support an association between the use of NSAIDs and risk of ovarian and endometrial cancers in a multiethnic population.

IMPACT

It is unlikely that NSAID is involved in the etiology of endometrial and ovarian cancer.