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Tanwar AK, Dhiman N, Kumar A, Jaitak V. Engagement of phytoestrogens in breast cancer suppression: Structural classification and mechanistic approach. Eur J Med Chem 2020; 213:113037. [PMID: 33257172 DOI: 10.1016/j.ejmech.2020.113037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022]
Abstract
Cancer is the world's devastating disease, and breast cancer is the most common reason for the death of women worldwide. Many synthetic drugs and medications are provided with their beneficial actions, but all of these have side effects and resistance problems. Natural remedies are coming forward to overcome the disadvantages of synthetic drugs. Among the natural categories, phytoestrogens having a structural similarity of mammalian oestradiol proves its benefit with various mechanisms not only in the treatment of breast cancer but even to prevent the occurrence of postmenopausal symptoms. Phytoestrogens are plant-derived compounds that were utilized in ancient medications and traditional knowledge for its sex hormone properties. Phytoestrogens exert pleiotropic effects on cellular signalling and show effects on estrogen-dependent diseases. However, because of activation/inhibition of steroid hormonal receptor ER-α or ER-β, these compounds induce or inhibit steroid hormonal (estrogen) action and, therefore, have the potential to disrupt hormone (estrogen) signalling pathway. In this review, we have discussed and summarize the effect of certain phytoestrogens and their possible mechanisms that can substantiate advantageous benefits for the treatment of post-menopausal symptoms as well as for breast cancer.
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Affiliation(s)
- Ankur Kumar Tanwar
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, Punjab, 151001, India
| | - Neha Dhiman
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, Punjab, 151001, India
| | - Amit Kumar
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, Punjab, 151001, India
| | - Vikas Jaitak
- Laboratory of Natural Products, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, Punjab, 151001, India.
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2
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de Paulo TRS, Viezel J, Aro BL, Seidinger SC, Trindade ACAC, Christofaro DGD, Freitas IF. Relationship between physical activity practice and metabolic profile of postmenopausal women under treatment with aromatase inhibitors for breast cancer. Eur J Obstet Gynecol Reprod Biol 2017; 216:33-37. [PMID: 28700959 DOI: 10.1016/j.ejogrb.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/06/2017] [Accepted: 07/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the relationship between physical activity practice and metabolic profile of postmenopausal women under treatment with aromatase inhibitors (AIs) for the treatment of breast cancer. STUDY DESIGN Cross-sectional study, conducted with 101 postmenopausal women (aged 50-80 years). The sample was divided into two groups; group without cancer (GW; n=65) and breast cancer group treated with AIs (GC; n=36). Physical activity (PA) was evaluated by questionnaire. Correlations between physical activity and metabolic variables were made by Pearson's correlation coefficient and the magnitude of these relationships by linear regression. RESULTS In GW, there were observed significant inverse correlations between physical activity and VLDL cholesterol (β=-0.036; 95% CI=-0.068; -0.004); triglycerides (β=-0.036; 95% CI=-0.015; -0.002); glycose (β=-0.029; 95% CI=-0.047; -0.012); and C-reactive protein (β=-0.44; 95% CI=-0.085; -0.003). However, for women under treatment of AIs there was no relationship between physical activity and metabolic variables. CONCLUSION The amount of physical activity practice is inversely related to lipid profile, glucose and C-reactive protein in women without breast cancer. This relation was not observed in the cancer survivors, suggesting that the use of aromatase inhibitors could influence or low intensity of physical activity.
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Affiliation(s)
- Thais R S de Paulo
- Institute of Bioscience, Department of Physical Education, Sao Paulo State University (UNESP), Rio Claro, SP, Brazil; Department of Physical Education, Federal University of Amazonas (UFAM), Parintins, AM, Brazil
| | - Juliana Viezel
- Institute of Bioscience, Department of Physical Education, Sao Paulo State University (UNESP), Rio Claro, SP, Brazil; Center of Studies and Laboratory of Evaluation and Prescription of Motor Activities (CELAPAM), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil.
| | - Bruna L Aro
- Center of Studies and Laboratory of Evaluation and Prescription of Motor Activities (CELAPAM), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Sylvia C Seidinger
- Center of Studies and Laboratory of Evaluation and Prescription of Motor Activities (CELAPAM), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Ana Carolina A C Trindade
- Center of Studies and Laboratory of Evaluation and Prescription of Motor Activities (CELAPAM), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Diego G D Christofaro
- Group of Study in Physical Activity and Health, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
| | - Ismael F Freitas
- Center of Studies and Laboratory of Evaluation and Prescription of Motor Activities (CELAPAM), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
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Baptissart M, Vega A, Martinot E, Baron S, Lobaccaro JMA, Volle DH. Farnesoid X receptor alpha: a molecular link between bile acids and steroid signaling? Cell Mol Life Sci 2013; 70:4511-26. [PMID: 23784309 PMCID: PMC11113643 DOI: 10.1007/s00018-013-1387-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 05/27/2013] [Accepted: 05/27/2013] [Indexed: 12/29/2022]
Abstract
Bile acids are cholesterol metabolites that have been extensively studied in recent decades. In addition to having ancestral roles in digestion and fat solubilization, bile acids have recently been described as signaling molecules involved in many physiological functions, such as glucose and energy metabolisms. These signaling pathways involve the activation of the nuclear receptor farnesoid X receptor (FXRα) or of the G protein-coupled receptor TGR5. In this review, we will focus on the emerging role of FXRα, suggesting important functions for the receptor in steroid metabolism. It has been described that FXRα is expressed in the adrenal glands and testes, where it seems to control steroid production. FXRα also participates in steroid catabolism in the liver and interferes with the steroid signaling pathways in target tissues via crosstalk with steroid receptors. In this review, we discuss the potential impacts of bile acid (BA), through its interactions with steroid metabolism, on glucose metabolism, sexual function, and prostate and breast cancers. Although several of the published reports rely on in vitro studies, they highlight the need to understand the interactions that may affect health. This effect is important because BA levels are increased in several pathophysiological conditions related to liver injuries. Additionally, BA receptors are targeted clinically using therapeutics to treat liver diseases, diabetes, and cancers.
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Affiliation(s)
- Marine Baptissart
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
| | - Aurelie Vega
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
| | - Emmanuelle Martinot
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
| | - Silvère Baron
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
| | - Jean-Marc A. Lobaccaro
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
| | - David H. Volle
- INSERM U1103, Génétique Reproduction et Développement (GReD), Clermont Université, 24 avenue des Landais, BP 80026, 63177 Aubière Cedex, France
- CNRS Unité Mixte de Recherche 6293, GReD, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Clermont Université, Université Blaise Pascal, BP 10448, 63000 Clermont-Ferrand, France
- Centre de Recherche en Nutrition Humaine d’Auvergne, 63000 Clermont-Ferrand, France
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Mostafa YA, Taylor SD. Steroid derivatives as inhibitors of steroid sulfatase. J Steroid Biochem Mol Biol 2013; 137:183-98. [PMID: 23391659 DOI: 10.1016/j.jsbmb.2013.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/10/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
Sulfated steroids function as a storage reservoir of biologically active steroid hormones. The sulfated steroids themselves are biologically inactive and only become active in vivo when they are converted into their desulfated (unconjugated) form by the enzyme steroid sulfatase (STS). Inhibitors of STS are considered to be potential therapeutics for the treatment of steroid-dependent cancers such as breast, prostate and endometrial cancer. The present review summarizes steroid derivatives as inhibitors of STS covering the literature from the early years of STS inhibitor development to October of 2012. A brief discussion of the function, structure and mechanism of STS and its role in estrogen receptor-positive (ER+) hormone-dependent breast cancer is also presented. This article is part of a Special Issue entitled "Synthesis and biological testing of steroid derivatives as inhibitors".
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Affiliation(s)
- Yaser A Mostafa
- Department of Chemistry, University of Waterloo, 200 University Ave. West, Waterloo, ON, Canada
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5
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Geisler J, Sasano H, Chen S, Purohit A. Steroid sulfatase inhibitors: promising new tools for breast cancer therapy? J Steroid Biochem Mol Biol 2011; 125:39-45. [PMID: 21356310 DOI: 10.1016/j.jsbmb.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 02/05/2011] [Accepted: 02/07/2011] [Indexed: 12/18/2022]
Abstract
Inhibition of aromatase is currently well-established as the major treatment option of hormone-dependent breast cancer in postmenopausal women. However, despite the effects of aromatase inhibitors in both early and metastatic breast cancer, endocrine resistance may cause relapses of the disease and progression of metastasis. Thus, driven by the success of manipulating the steroidogenic enzyme aromatase, several alternative enzymes involved in steroid synthesis and metabolism have recently been investigated as possible drug targets. One of the most promising targets is the steroid sulfatase (STS) which converts steroid sulfates like estrone sulfate (E1S) and dehydroepiandrosterone sulfate (DHEAS) to estrone (E1) and dehydroepiandrosterone (DHEA), respectively. Estrone and DHEA may thereafter be used for the synthesis of more potent estrogens and androgens that may eventually fuel hormone-sensitive breast cancer cells. The present review summarizes the biology behind steroid sulfatase and its inhibition, the currently available information derived from basic and early clinical trials in breast cancer patients, as well as ongoing research. Article from the Special Issue on Targeted Inhibitors.
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Affiliation(s)
- Jürgen Geisler
- Institute of Clinical Medicine, Division of Clinical Medicine and Laboratory Sciences, University of Oslo, Norway.
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6
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Geisler J, Suzuki T, Helle H, Miki Y, Nagasaki S, Duong NK, Ekse D, Aas T, Evans DB, Lønning PE, Sasano H. Breast cancer aromatase expression evaluated by the novel antibody 677: correlations to intra-tumor estrogen levels and hormone receptor status. J Steroid Biochem Mol Biol 2010; 118:237-41. [PMID: 19883757 DOI: 10.1016/j.jsbmb.2009.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 10/19/2009] [Accepted: 10/21/2009] [Indexed: 11/28/2022]
Abstract
Breast cancer tissue estrogen levels on an average exceed plasma as well as benign breast tissue levels. To evaluate the contribution of intra-tumor aromatization to individual tumor estrogen levels (estradiol, E2; estrone, E1; estrone sulfate, E1S), breast cancer tissue sections obtained during mastectomy in 28 postmenopausal breast cancer patients were stained for aromatase protein expression using the aromatase antibody 677. The findings were correlated to intra-tumor estrogen levels determined with a highly sensitive HPLC-RIA. Staining with 677 alone (irrespective of the hormone receptor status) revealed no difference in tumor E2 levels comparing 677+ versus 677- tumors, although a non-significant trend towards higher tumor E1 and E1S levels was observed in 677+ breast cancers. In contrast, tumor levels of E(2) were significantly higher in ER+ tumors compared to ER- tumors (P<0.001) and to benign breast tissue from the same breast (P<0.001). Analysing the additional effect of positive staining with the aromatase antibody 677 on tumor estrogen levels in the subgroup of ER+ tumors, revealed significantly higher tumor levels of E2 (mean level of 544.7 versus 197.1 fmol/g tissue) as well as a non-significant trend concerning tumor E1 (mean level of 296.9 versus 102.1 fmol/g tissue). The mean tumor tissue E1S level was observed somewhat lower in ER+677+ (103.5 fmol/g) versus ER+677- tumors (190.1 fmol/g). In the subgroup of ER+PgR+ tumors, tissue levels of E2 were also found to be significantly higher among 677+ compared to 677- tumors: 873.2 fmol/g (95% CI 395.9-1925.6) versus 217.9 fmol/g (95% CI 88.8-534.9) (P=0.015). In conclusion, our results indicate a moderate effect of aromatase enzyme expression evaluated by IHC using the antibody 677 on intra-tumor estrogen levels among ER+ breast cancers. A substantial interindividual variation in the ratios between the individual estrogen fractions suggests additional effects, like alterations in other enzymes to be involved in the intra-tumor estrogen homeostasis.
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Affiliation(s)
- Jürgen Geisler
- Section of Oncology, Institute of Medicine, University of Bergen, N-5021 Bergen, Norway.
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Lønning PE, Helle H, Duong NK, Ekse D, Aas T, Geisler J. Tissue estradiol is selectively elevated in receptor positive breast cancers while tumour estrone is reduced independent of receptor status. J Steroid Biochem Mol Biol 2009; 117:31-41. [PMID: 19591931 DOI: 10.1016/j.jsbmb.2009.06.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 06/24/2009] [Accepted: 06/26/2009] [Indexed: 01/29/2023]
Abstract
Previous studies have suggested elevated estrogen production in tumour-bearing breast quadrants as well as in breast cancers versus benign tissue. Using highly sensitive assays, we determined breast cancer tissue estrogen concentrations together with plasma and benign tissue estrogen concentrations in each quadrant obtained from mastectomy specimens (34 postmenopausal and 13 premenopausal women). We detected similar concentrations of each of the three major estrogens estradiol (E(2)), estrone (E(1)) and E(1)S in tumour-bearing versus non-tumour-bearing quadrants. Considering malignant tumours, intratumour E(1) levels were reduced in cancer tissue obtained from pre- as well as postmenopausal women independent of tumour ER status (average ratio E(1) cancer: benign tissue of 0.2 and 0.3, respectively; p<0.001 for both groups), suggesting intratumour aromatization to be of minor importance. The most striking finding was a significant (4.1-8.6-fold) increased E(2) concentration in ER positive tumours versus normal tissue (p<0.05 and <0.001 for pre- and postmenopausal patients, respectively), contrasting low E(2) concentrations in ER- tumours (p<0.01 and <0.001 comparing E(2) levels between ER+ and ER- tumours in pre- and postmenopausals, respectively). A possible explanation to our finding is increased ligand receptor binding capacity for E(2) in receptor positive tumours but alternative factors influencing intratumour estrogen disposition cannot be excluded.
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Affiliation(s)
- P E Lønning
- Section of Oncology, Institute of Medicine, University of Bergen, Jonas Lies vei 26, N-5021 Bergen, Norway.
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Santen RJ, Brodie H, Simpson ER, Siiteri PK, Brodie A. History of aromatase: saga of an important biological mediator and therapeutic target. Endocr Rev 2009; 30:343-75. [PMID: 19389994 DOI: 10.1210/er.2008-0016] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aromatase is the enzyme that catalyzes the conversion of androgens to estrogens. Initial studies of its enzymatic activity and function took place in an environment focused on estrogen as a component of the birth control pill. At an early stage, investigators recognized that inhibition of this enzyme could have major practical applications for treatment of hormone-dependent breast cancer, alterations of ovarian and endometrial function, and treatment of benign disorders such as gynecomastia. Two general approaches ultimately led to the development of potent and selective aromatase inhibitors. One targeted the enzyme using analogs of natural steroidal substrates to work out the relationships between structure and function. The other approach initially sought to block adrenal function as a treatment for breast cancer but led to the serendipitous finding that a nonsteroidal P450 steroidogenesis inhibitor, aminoglutethimide, served as a potent but nonselective aromatase inhibitor. Proof of the therapeutic concept of aromatase inhibition involved a variety of studies with aminoglutethimide and the selective steroidal inhibitor, formestane. The requirement for even more potent and selective inhibitors led to intensive molecular studies to identify the structure of aromatase, to development of high-sensitivity estrogen assays, and to "mega" clinical trials of the third-generation aromatase inhibitors, letrozole, anastrozole, and exemestane, which are now in clinical use in breast cancer. During these studies, unexpected findings led investigators to appreciate the important role of estrogens in males as well as in females and in multiple organs, particularly the bone and brain. These studies identified the important regulatory properties of aromatase acting in an autocrine, paracrine, intracrine, neurocrine, and juxtacrine fashion and the organ-specific enhancers and promoters controlling its transcription. The saga of these studies of aromatase and the ultimate utilization of inhibitors as highly effective treatments of breast cancer and for use in reproductive disorders serves as the basis for this first Endocrine Reviews history manuscript.
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Affiliation(s)
- R J Santen
- University of Virginia Health System, Division of Endocrinology, P.O. Box 801416, Charlottesville, Virginia 22908, USA.
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Lønning PE, Geisler J. Experience with Exemestane in the Treatment of Early and Advanced Breast Cancer. Expert Opin Drug Metab Toxicol 2008; 4:987-97. [DOI: 10.1517/17425255.4.7.987] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fontaine C, Meulemans A, Huizing M, Collen C, Kaufman L, De Mey J, Bourgain C, Verfaillie G, Lamote J, Sacre R, Schallier D, Neyns B, Vermorken J, De Grève J. Tolerance of adjuvant letrozole outside of clinical trials. Breast 2008; 17:376-81. [PMID: 18455395 DOI: 10.1016/j.breast.2008.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 02/19/2008] [Accepted: 02/22/2008] [Indexed: 11/20/2022] Open
Abstract
Recently aromatase inhibitors have become a standard care as an adjuvant treatment for many postmenopausal patients with hormone receptor positive early breast cancer. Adjuvant letrozole was made available either immediately postoperative, after 2-3 years of tamoxifen, or as an extended treatment after 5 years of tamoxifen. Between October 2003 and October 2005, we analyzed the subjective tolerance in 185 postoperative early breast cancer patients receiving letrozole outside of a clinical trial. The most prominent toxicity was musculoskeletal pain. In addition hot flushes, increased fatigue, nausea, vomiting, anorexia, mood disturbances, vaginal dryness, hair loss and rash were also recorded. In contrast to the prospective randomized clinical trials, a high drop-out rate of 20% was documented, mainly due to aromatase inhibitor-associated arthralgia syndrome interfering significantly with the daily life of our patients. Although adjuvant aromatase inhibitors have proven to be generally superior to tamoxifen in the adjuvant setting, it is important to focus attention on the tolerance during the adjuvant therapy and to balance this against the potential benefit in individual patients. Alternative options including switching to tamoxifen remain available.
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Affiliation(s)
- C Fontaine
- Department of Medical Oncology, Oncologisch Centrum, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Jette, Belgium
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Lønning PE, Geisler J. Indications and limitations of third-generation aromatase inhibitors. Expert Opin Investig Drugs 2008; 17:723-39. [DOI: 10.1517/13543784.17.5.723] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Koeberle D, Thuerlimann B. Letrozole as upfront endocrine therapy for postmenopausal women with hormone-sensitive breast cancer: BIG 1-98. Breast Cancer Res Treat 2007; 105 Suppl 1:55-66. [PMID: 17912636 PMCID: PMC2001218 DOI: 10.1007/s10549-007-9700-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 07/17/2007] [Indexed: 11/29/2022]
Abstract
The BIG 1-98 trial is a large, randomized, independently conducted clinical trial designed to compare the efficacy of upfront letrozole versus tamoxifen monotherapy and to compare sequential or up-front use of letrozole and/or tamoxifen as an early adjuvant therapy for patients with early breast cancer. We report on the results from the primary core analysis of the BIG 1-98 trial of 8,010 patients, which compares monotherapy with letrozole versus tamoxifen. This pre-planned core analysis allowed the use of patient data from the monotherapy arms of letrozole and tamoxifen and from the sequential arms prior to the drug switch point. Patients randomized to letrozole had a 19% improved disease-free survival (hazard ratio [HR]=0.81; P=0.003), due especially to reduced distant metastases (HR=0.73; P=0.001). A 14% risk reduction of fatal events in favor of letrozole was also observed (P=NS). The results from the monotherapy arms alone confirmed the findings from the primary core analysis. Based on the results from this trial, the aromatase inhibitor letrozole (Femara) is currently recommended as a part of standard adjuvant therapy for postmenopausal women with endocrine-responsive breast cancer and has recently been approved in the early adjuvant setting in both Europe and the United States. A subsequent analysis after additional follow-up will address the question of monotherapy versus sequential therapy.
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Affiliation(s)
- Dieter Koeberle
- Department of Internal Medicine, Division Oncology/Hematology, Kantonsspital, CH-9007 St. Gallen, Switzerland
| | - Beat Thuerlimann
- Department of Internal Medicine, Division Oncology/Hematology, Kantonsspital, CH-9007 St. Gallen, Switzerland
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Sidell N, Kirma N, Morgan ET, Nair H, Tekmal RR. Inhibition of estrogen-induced mammary tumor formation in MMTV-aromatase transgenic mice by 4-chlorophenylacetate. Cancer Lett 2007; 251:302-10. [PMID: 17215075 PMCID: PMC1940067 DOI: 10.1016/j.canlet.2006.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 11/07/2006] [Accepted: 11/28/2006] [Indexed: 11/26/2022]
Abstract
Treatment of estrogen-sensitive breast cancer with selective estrogen selective modulators (SERMs) and, more recently, aromatase inhibitors has met with wide success. However, antagonism of estrogen receptor (ER) activity in breast carcinomas by SERMs such as tamoxifen has been associated with increased risk of cancer in other tissue such as the endometrium. Furthermore, current therapies using aromatase inhibitors have side effects on bone resulting in development of osteoporosis in some patients. We present in this paper the results of a study using 4-chlorophenylacetate (4-CPA), a compound which belongs to a family of small aromatic fatty acids that has been shown to possess anticancer properties, to treat DMBA exposed MMTV-aromatase mice. These animals exhibit elevated levels of estrogen in their mammary glands and develop estrogen-responsive tumors. Consistent with our earlier findings showing that 4-CPA inhibited the growth of ER positive breast cancer cells in vitro, we now demonstrate that this compound inhibits tumor formation in MMTV-aromatase mice. This effect was not associated with reduction of ER expression in their mammary tissue, or to alteration of aromatase levels or activity. The data suggest that 4-CPA is a novel therapeutic agent that could be used in the prevention or treatment of estrogen-sensitive breast cancer.
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Affiliation(s)
- Neil Sidell
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
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Lonning E. Reply to ‘Conclusions regarding relative cost–utility of alternative strategies for use of aromatase inhibitors in postmenopausal women with early breast cancer are premature’ by Delea et al. Ann Oncol 2007; 18:198-199. [DOI: 10.1093/annonc/mdl170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morales L, Pans S, Paridaens R, Westhovens R, Timmerman D, Verhaeghe J, Wildiers H, Leunen K, Amant F, Berteloot P, Smeets A, Van Limbergen E, Weltens C, Van den Bogaert W, De Smet L, Vergote I, Christiaens MR, Neven P. Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging. Breast Cancer Res Treat 2006; 104:87-91. [PMID: 17061044 DOI: 10.1007/s10549-006-9394-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Arthralgia, skeletal and muscle pain have been reported in postmenopausal women under treatment with third generation aromatase inhibitors (AIs). However, the pathogenesis and anatomic correlate of musculoskeletal pains have not been thoroughly evaluated. Moreover, the impact of AI-induced musculoskeletal symptoms on normal daily functioning needs to be further explored. PATIENTS AND METHODS We examined 12 consecutive non-metastatic breast cancer patients who reported severe musculoskeletal pain under a third generation AI; 11 were on letrozole and 1 on exemestane. Clinical rheumatological examination and serum biochemistry were performed. Radiological evaluation of the hand/wrist joints were performed using ultrasound (US) and/or magnetic resonance imaging (MRI). RESULTS The most common reported symptom was severe early morning stiffness and hand/wrist pain causing impaired ability to completely close/stretch the hand/fingers and to perform daily activities and work-related skills. Six patients had to discontinue treatment due to severe symptoms. Trigger finger and carpal tunnel syndrome were the most frequently reported clinical signs. US showed fluid in the tendon sheath surrounding the digital flexor tendons. On MRI, an enhancement and thickening of the tendon sheath was a constant finding in all 12 patients. CONCLUSIONS Musculoskeletal pains in breast cancer patients under third generation AIs can be severe, debilitating, and can limit compliance. Characteristic tenosynovial, and in some patients joint changes on US and MRI were observed in this series and have not been reported before.
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Affiliation(s)
- Leilani Morales
- Department of General Medical Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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Geisler J, Lønning PE, Krag LE, Løkkevik E, Risberg T, Hagen AI, Schlichting E, Lien EA, Ofjord ES, Eide GE, Polli A, di Salle E, Paolini J. Changes in bone and lipid metabolism in postmenopausal women with early breast cancer after terminating 2-year treatment with exemestane: a randomised, placebo-controlled study. Eur J Cancer 2006; 42:2968-75. [PMID: 16963261 DOI: 10.1016/j.ejca.2006.07.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 06/28/2006] [Accepted: 07/11/2006] [Indexed: 11/21/2022]
Abstract
Aromatase inhibitors improve relapse-free survival in early breast cancer, but there is concern about possible detrimental effects on bone mineral density (BMD) and plasma lipids. This paper presents the results of a 2-year study evaluating the effects of exemestane versus placebo on BMD, bone markers, plasma lipids and coagulation factors, including a 1-year follow-up after termination of treatment in 147 patients. During treatment, the mean annual rate of loss of BMD in the lumbar spine was 2.17% in the exemestane group versus 1.84% in the placebo group (n.s.) and 2.72% versus 1.48%, respectively, in the femoral neck (P=0.024). A loss of BMD above that expected in both arms of this study could be due to low vitamin D status (88% of all patients had vitamin D levels <30 ng/ml). The changes observed with exemestane were partially reversed during a 1-year follow-up, with no significant difference between the two arms. Similarly, the moderate decrease in high-density lipoprotein (HDL)-cholesterol was reversed. The bone marker values decreased, although a difference at 6 months of follow-up was still recorded, in particular for the markers of bone synthesis.
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Affiliation(s)
- J Geisler
- Section of Oncology, Department of Medicine, Haukeland University Hospital, University of Bergen, NO-5021, Bergen, Norway
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