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Kumar A, Kurmi BD, Singh D. Development and Method Validation of Design of Experiments-Optimized Tablet Formulation for Simultaneous Detection of Exemestane and Everolimus. Assay Drug Dev Technol 2023; 21:273-287. [PMID: 37682343 DOI: 10.1089/adt.2023.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
The development and analysis of pharmaceutical formulations often involves the determination of multiple active ingredients in a dosage form. The aim of the present study is to develop a convenient method for simultaneous estimation of Exemestane (EXE) and Everolimus (EVE) in bulk and in systemically designed tablet dosage form. Methanol was used as a solvent for developing linear curves and validated in terms of various parameters, such as selectivity, sensitivity, linearity, precision, accuracy, and robustness. Method validation observed that the proposed method is reliable and reproducible, meeting the regulatory requirements for pharmaceutical analysis with a relative standard deviation of <2%. The developed method was found to be sensitive and selective in simultaneous equation method. The unknown concentrations of EVE and EXE were found to be 10.431 and 10.232, respectively. The next step is to systematically design a tablet formulation for EXE and EVE containing β-cyclodextrin as a polymer. Microcrystalline cellulose (X1), sodium starch glycolate (X2), and beta-cyclodextrin (X3) are the critical variables and hardness (Y2) and friability (Y3) were selected as prime responses. Analysis of variance provides significance of the model, and the predicted batch gives a high desirability value of 0.862. In vitro dissolution profiles of optimized batch (OB1) were signified by high drug release profile as 89.47% and 96.00% for EVE and EXE in tablet formulation, as compared with pure API, respectively. This study signifies enhancement in biopharmaceutical attributes of EXE and EVE in tablet formulation and robust simultaneous estimation by the UV method. In a nutshell, this study provides the simultaneous estimation method in tablet dosage form, and further research is crucial for the advancement of pharmaceutical analysis and the formulation of effective medicines.
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Affiliation(s)
- Akshay Kumar
- Department of Quality Assurance and ISF College of Pharmacy, Moga, Punjab, India
| | - Balak Das Kurmi
- Department of Quality Assurance and ISF College of Pharmacy, Moga, Punjab, India
| | - Dilpreet Singh
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab, India
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Gabriel L, Schmidt M, Juhasz-Böss S, Melchior P, von Heesen A, Schmidt G, Kranzhöfer N, Solomayer EF, Juhasz-Böss I, Breitbach GP. Therapy of isolated locoregional recurrent carcinoma of the breast. Arch Gynecol Obstet 2019; 300:365-376. [PMID: 31222400 DOI: 10.1007/s00404-019-05220-x] [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: 01/16/2019] [Accepted: 06/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE There is widespread consent that isolated locoregional recurrence (ILRR) in breast cancer should be treated surgically. On searching literature and guidelines most studies include ipsilateral recurrence in breast tissue or on thoracic wall post-mastectomy, recurrence in scar tissue as well as in ipsilateral axillary lymph nodes. Some studies discuss metachronous contralateral breast cancer as ILRR. About 10-35% of women with primary breast cancer suffer from ILRR. The existing data concerning the role of systemic therapy in the treatment of ILRR are insufficient. We investigated the influence of chemotherapy on disease-free- (DFS) and overall-survival (OS). METHODS Retrospective analysis of all patients with ILRR and without distant metastasis was done, which were treated at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University between 2005 and 2013. Data collection used patients' database system and was followed via patient questionnaires. RESULTS In total, we collected data of 93 patients with locally recurrent breast cancer and observed a 72.6% questionnaire response rate. Average timeline accounted for 99 months between primary diagnosis and local recurrence; average age of patients at diagnosis of local recurrence was 60.6 years. After a median follow-up of 63 months DFS reached 76% with and 73% without chemotherapy, and after 74 months overall survival amounted to 94% and 70%, respectively. CONCLUSION Almost all patients with ILRR were operated. Especially patients with hormone receptor-negative recurrent breast cancer seemed to show a benefit having been treated with chemotherapy. Most patients were without recurrence after their particular therapies.
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Affiliation(s)
- Lena Gabriel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Marina Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Stephanie Juhasz-Böss
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Patrick Melchior
- Department of Radiation Oncology, University Hospital Medical School, Homburg, Germany
| | - Anika von Heesen
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Gilda Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Nicole Kranzhöfer
- Department for Oncology and Hematology, University Hospital Medical School, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Ingolf Juhasz-Böss
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany
| | - Georg-Peter Breitbach
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Medical School, Kirrbergerstraße 100, 66421, Homburg/Saar, Germany.
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Luo S, Chen G, Truica CI, Baird CC, Xia Z, Lazarus P. Identification and Quantification of Novel Major Metabolites of the Steroidal Aromatase Inhibitor, Exemestane. Drug Metab Dispos 2018; 46:1867-1878. [PMID: 30257855 PMCID: PMC7333658 DOI: 10.1124/dmd.118.081166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/14/2018] [Indexed: 01/03/2023] Open
Abstract
Exemestane (EXE) is an aromatase inhibitor used for the prevention and treatment of estrogen receptor–positive breast cancer. Although the known major metabolic pathway for EXE is reduction to form the active 17β-dihydro-EXE (17β-DHE) and subsequent glucuronidation to 17β-hydroxy-EXE-17-O-β-D-glucuronide (17β-DHE-Gluc), previous studies have suggested that other major metabolites exist for exemestane. In the present study, a liquid chromatography–mass spectrometry (LC-MS) approach was used to acquire accurate mass data in MSE mode, in which precursor ion and fragment ion data were obtained simultaneously to screen novel phase II EXE metabolites in urine specimens from women taking EXE. Two major metabolites predicted to be cysteine conjugates of EXE and 17β-DHE by elemental composition were identified. The structures of the two metabolites were confirmed to be 6-methylcysteinylandrosta-1,4-diene-3,17-dione (6-EXE-cys) and 6-methylcysteinylandrosta-1,4-diene-17β-hydroxy-3-one (6-17β-DHE-cys) after comparison with their chemically synthesized counterparts. Both underwent biosynthesis in vitro in three stepwise enzymatic reactions, with the first involving glutathione conjugation. The cysteine conjugates of EXE and 17β-DHE were subsequently quantified by liquid chromatography–mass spectrometry in the urine and matched plasma samples of 132 subjects taking EXE. The combined 6-EXE-cys plus 6-17β-DHE-cys made up 77% of total EXE metabolites in urine (vs. 1.7%, 0.14%, and 21% for EXE, 17β-DHE, and 17β-DHE-Gluc, respectively) and 35% in plasma (vs. 17%, 12%, and 36% for EXE, 17β-DHE, and 17β-DHE-Gluc, respectively). Therefore, cysteine conjugates of EXE and 17β-DHE appear to be major metabolites of EXE in both urine and plasma.
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Affiliation(s)
- Shaman Luo
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Gang Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Cristina I Truica
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Cynthia C Baird
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Zuping Xia
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (S.L., G.C., Z.X., P.L.); Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania (C.I.T., C.C.B.); and Alkali Soil Natural Environmental Science Center, Northeast Forestry University, Harbin, Heilongjiang, China (S.L.)
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Role of the UGT2B17 deletion in exemestane pharmacogenetics. THE PHARMACOGENOMICS JOURNAL 2017; 18:295-300. [PMID: 28534527 PMCID: PMC5700874 DOI: 10.1038/tpj.2017.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/11/2016] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Abstract
Exemestane (EXE) is an aromatase inhibitor used for the prevention and treatment of breast cancer. The major metabolic pathway for EXE is reduction to form the active 17β-dihydro-EXE (17β-DHE) and subsequent glucuronidation to 17β-hydroxy-EXE-17-O-β-D-glucuronide (17β-DHE-Gluc) by UGT2B17. The aim of the present study was to determine the effects of UGT2B17 copy number variation on the levels of urinary and plasma 17β-DHE-Gluc and 17β-DHE in patients taking EXE. Ninety-six post-menopausal Caucasian breast cancer patients with ER+ breast tumors taking 25 mg EXE daily were recruited into this study. UGT2B17 copy number was determined by a real-time PCR copy number variant assay and the levels of EXE, 17β-DHE and 17β-DHE-Gluc were quantified by UPLC/MS in patients’ urine and plasma. A 39-fold decrease (P<0.0001) in the levels of creatinine-adjusted urinary 17β-DHE-Gluc was observed among UGT2B17 (*2/*2) subjects vs. subjects with the UGT2B17 (*1/*1) genotype. The plasma levels of 17β-DHE-Gluc was decreased 29-fold (P<0.0001) in subjects with the UGT2B17 (*2/*2) genotype vs. subjects with UGT2B17 (*1/*1) genotype. The levels of plasma EXE-adjusted 17β-DHE was 28% higher (P=0.04) in subjects with the UGT2B17 (*2/*2) genotype vs. subjects with the UGT2B17 (*1/*1) genotype. These data indicate that UGT2B17 is the major enzyme responsible for 17β-DHE-Gluc formation in vivo and that the UGT2B17 copy number variant may play a role in inter-individual variability in 17β-DHE levels in vivo.
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Brufsky AM. Managing postmenopausal women with hormone receptor-positive advanced breast cancer who progress on endocrine therapies with inhibitors of the PI3K pathway. Breast J 2014; 20:347-57. [PMID: 24861776 DOI: 10.1111/tbj.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although endocrine therapies that interfere with estrogen receptor (ER)-mediated signaling have revolutionized the management of postmenopausal women with hormone receptor-positive (HR+) breast cancer (BC), long-term management of these patients is suboptimal because of the eventual emergence of endocrine resistance. Intense research has elucidated a number of targets that act downstream or upstream of the ER, as well as those that crosstalk with the ER; however, clinical validation of inhibiting specific targets to overcome endocrine resistance has been lacking. The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway has been implicated to mediate endocrine resistance, and a number of novel agents that target this pathway are in early- and late-stage clinical trials. Recently, everolimus, an inhibitor of mTOR, a critical component of the PI3K/AKT/mTOR pathway, in combination with endocrine therapy, was shown to prolong progression-free survival with a manageable adverse-event profile in postmenopausal patients with HR+ BC. Bolstered by the safety and efficacy observed with concomitant inhibition of the ER and the PI3K/mTOR pathway and the validation of dual inhibition approach in managing postmenopausal patients with HR+ BC, a number of novel agents that inhibit PI3K (pan-PI3K inhibitors) or PI3K and mTOR (dual PI3K/mTOR) are being evaluated in clinical trials. Thus, mTOR inhibitors have provided the much-needed ammunition to oncologists who manage postmenopausal women with BC and have paved the way for the development of novel therapies that target the PI3K/mTOR pathway. Use of these novel therapies in managing postmenopausal women with BC, in combination with endocrine therapies, is expected to improve overall outcomes by overcoming endocrine resistance.
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Affiliation(s)
- Adam M Brufsky
- Magee-Women's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Glück S. Extending the Clinical Benefit of Endocrine Therapy for Women With Hormone Receptor–Positive Metastatic Breast Cancer: Differentiating Mechanisms of Action. Clin Breast Cancer 2014; 14:75-84. [DOI: 10.1016/j.clbc.2013.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/04/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
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Aromatase inhibitors in the treatment of elderly women with metastatic breast cancer. Breast 2013; 22:142-149. [PMID: 23321585 DOI: 10.1016/j.breast.2012.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/26/2012] [Accepted: 12/17/2012] [Indexed: 11/22/2022] Open
Abstract
The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.
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Michael Miller KK, Al-Rayyan N, Ivanova MM, Mattingly KA, Ripp SL, Klinge CM, Prough RA. DHEA metabolites activate estrogen receptors alpha and beta. Steroids 2013; 78:15-25. [PMID: 23123738 PMCID: PMC3529809 DOI: 10.1016/j.steroids.2012.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/17/2012] [Accepted: 10/17/2012] [Indexed: 11/22/2022]
Abstract
Dehydroepiandrosterone (DHEA) levels were reported to associate with increased breast cancer risk in postmenopausal women, but some carcinogen-induced rat mammary tumor studies question this claim. The purpose of this study was to determine how DHEA and its metabolites affect estrogen receptors α or β (ERα or ERβ)-regulated gene transcription and cell proliferation. In transiently transfected HEK-293 cells, androstenediol, DHEA, and DHEA-S activated ERα. In ERβ transfected HepG2 cells, androstenedione, DHEA, androstenediol, and 7-oxo DHEA stimulated reporter activity. ER antagonists ICI 182,780 (fulvestrant) and 4-hydroxytamoxifen, general P450 inhibitor miconazole, and aromatase inhibitor exemestane inhibited activation by DHEA or metabolites in transfected cells. ERβ-selective antagonist R,R-THC (R,R-cis-diethyl tetrahydrochrysene) inhibited DHEA and DHEA metabolite transcriptional activity in ERβ-transfected cells. Expression of endogenous estrogen-regulated genes: pS2, progesterone receptor, cathepsin D1, and nuclear respiratory factor-1 was increased by DHEA and its metabolites in an ER-subtype, gene, and cell-specific manner. DHEA metabolites, but not DHEA, competed with 17β-estradiol for ERα and ERβ binding and stimulated MCF-7 cell proliferation, demonstrating that DHEA metabolites interact directly with ERα and ERβin vitro, modulating estrogen target genes in vivo.
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Affiliation(s)
| | | | | | | | | | - Carolyn M. Klinge
- CORRESPONDING AUTHORS: Russell A. Prough, Ph.D., and Carolyn M. Klinge. Ph.D. Department of Biochemistry & Molecular Biology, University of Louisville School of Medicine, Louisville, KY 40292. Phone: (502) 852-7249 (RAP); 502-852-3668 (CMK); FAX: (502) 852-6222; and
| | - Russell A. Prough
- CORRESPONDING AUTHORS: Russell A. Prough, Ph.D., and Carolyn M. Klinge. Ph.D. Department of Biochemistry & Molecular Biology, University of Louisville School of Medicine, Louisville, KY 40292. Phone: (502) 852-7249 (RAP); 502-852-3668 (CMK); FAX: (502) 852-6222; and
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Amaral C, Borges M, Melo S, da Silva ET, Correia-da-Silva G, Teixeira N. Apoptosis and autophagy in breast cancer cells following exemestane treatment. PLoS One 2012; 7:e42398. [PMID: 22912703 PMCID: PMC3418278 DOI: 10.1371/journal.pone.0042398] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/05/2012] [Indexed: 01/11/2023] Open
Abstract
Aromatase inhibitors (AIs), which block the conversion of androgens to estrogens, are used for hormone-dependent breast cancer treatment. Exemestane, a steroidal that belongs to the third-generation of AIs, is a mechanism-based inhibitor that binds covalently and irreversibly, inactivating and destabilizing aromatase. Since the biological effects of exemestane in breast cancer cells are not totally understood, its effects on cell viability, cell proliferation and mechanisms of cell death were studied in an ER-positive aromatase-overexpressing breast cancer cell line (MCF-7aro). The effects of 3-methyladenine (3-MA), an inhibitor of autophagy and of ZVAD-FMK, an apoptotic inhibitor, in exemestane treated cells were also investigated. Our results indicate that exemestane induces a strong inhibition in MCF-7aro cell proliferation in a dose- and time-dependent manner, promoting a significant cell cycle arrest in G(0)/G1 or in G(2)/M phases after 3 and 6 days of treatment, respectively. This was accompanied by a decrease in cell viability due to activation of cell death by apoptosis, via mitochondrial pathway and the occurrence of autophagy. Inhibition of autophagy by the autophagic inhibitor, 3-MA, resulted in a reduction of cell viability and activation of caspases. All together the results obtained suggest that exemestane induced mitochondrial-mediated apoptosis and autophagy, which act as a pro-survival process regulating breast cancer cell apoptosis.
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Affiliation(s)
- Cristina Amaral
- Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Margarida Borges
- Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Soraia Melo
- Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Department of Zoology, Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal
| | - Elisiário Tavares da Silva
- Center of Pharmaceutical Studies, Pharmaceutical Chemistry Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Georgina Correia-da-Silva
- Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Natércia Teixeira
- Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
- * E-mail:
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Cruz Jurado J, Richart Aznar P, García Mata J, Fernández Martínez R, Peláez Fernández I, Sampedro Gimeno T, Galve Calvo E, Murillo Jaso L, Polo Marqués E, García Palomo A. Management of patients with metastatic breast cancer. Adv Ther 2011; 28 Suppl 6:50-65. [PMID: 21922395 DOI: 10.1007/s12325-011-0046-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Indexed: 11/29/2022]
Abstract
Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.
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Affiliation(s)
- J Cruz Jurado
- Oncology Department, Hospital Universitario Canarias, S/C Tenerife, Islas Canarias, Spain
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