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Alfaris I, Asselah J, Aziz H, Bouganim N, Mousavi N. The Cardiovascular Risks Associated with Aromatase Inhibitors, Tamoxifen, and GnRH Agonists in Women with Breast Cancer. Curr Atheroscler Rep 2023; 25:145-154. [PMID: 36848014 DOI: 10.1007/s11883-023-01085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease accounts for up to 10% of all-cause mortality in women with a diagnosis of breast cancer, and the causes for this are multifaceted. Many women at risk of or with a diagnosis of breast cancer are on endocrine-modulating therapies. It is therefore important to understand the effect of hormone therapies on cardiovascular outcomes in breast cancer patients to mitigate against any adverse effects and to identify those most at risk so that they can be proactively managed. Here we discuss the pathophysiology of these agents, their effect on the cardiovascular system, and the latest evidence on their cardiovascular risks association. RECENT FINDINGS Tamoxifen appears to be cardioprotective during treatment but not over the longer term, while the effect of AIs on cardiovascular outcomes remains controversial. Heart failure outcomes remain understudied, and the cardiovascular effects of gonadotrophin-releasing hormone agonists (GNRHa) in women need further research, especially since data from men with prostate cancer have indicated an increased risk of cardiac events in GNRHa users. There remains a need for a greater understanding of the effects of hormone therapies on cardiovascular outcomes in breast cancer patients. Further areas of research in this area include developing evidence to better define the optimal preventive and screening methods for cardiovascular effects and the risk factors for patients on hormonal therapies.
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Affiliation(s)
- Ibrahim Alfaris
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Canada.
| | - Jamil Asselah
- Department of Oncology, McGill University Health Center, Montreal, Canada
| | - Haya Aziz
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health Center, Montreal, Canada
| | - Negareh Mousavi
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Canada
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Matthews AA, Peacock Hinton S, Stanway S, Lyon AR, Smeeth L, Lund JL, Bhaskaran K. Endocrine therapy use and cardiovascular risk in postmenopausal breast cancer survivors. Heart 2020; 107:1327-1335. [PMID: 33177117 PMCID: PMC8327412 DOI: 10.1136/heartjnl-2020-317510] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/03/2022] Open
Abstract
Objective Examine the effect of tamoxifen and aromatase inhibitors (AIs) on the risk of 12 clinically relevant cardiovascular outcomes in postmenopausal female breast cancer survivors. Methods We carried out two prospective cohort studies among postmenopausal women with breast cancer in UK primary care and hospital data (2002–2016) and US Surveillance, Epidemiology and End Results-Medicare data (2008–2013). Using Cox adjusted proportional hazards models, we compared cardiovascular risks between AI and tamoxifen users; and in the USA, between users of both drug classes and women receiving no endocrine therapy. Results 10 005 (UK) and 22 027 (USA) women with postmenopausal breast cancer were included. In both countries, there were higher coronary artery disease risks in AI compared with tamoxifen users (UK age-standardised incidence rate: 10.17 vs 7.51 per 1000 person-years, HR: 1.29, 95% CI 0.94 to 1.76; US age-standardised incidence rate: 36.82 vs 26.02 per 1000 person-years, HR: 1.29, 95% C I1.06 to 1.55). However, comparisons with those receiving no endocrine therapy (US data) showed no higher risk for either drug class and a lower risk in tamoxifen users (age-standardised incidence rate tamoxifen vs unexposed: 26.02 vs 35.19 per 1000 person-years, HR: 0.74, 95% 0.60 to 0.92; age-standardised incidence rate AI vs unexposed: 36.82 vs 35.19, HR: 0.96, 95% CI 0.83 to 1.10). Similar patterns were seen for other cardiovascular outcomes (arrhythmia, heart failure and valvular heart disease). As expected, there was more venous thromboembolism in tamoxifen compared with both AI users and those unexposed. Conclusions Higher risks of several cardiovascular outcomes among AI compared with tamoxifen users appeared to be driven by protective effects of tamoxifen, rather than cardiotoxic effects of AIs.
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Affiliation(s)
- Anthony A Matthews
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden .,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sharon Peacock Hinton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susannah Stanway
- Departmnet of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alexander Richard Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,Royal Brompton and Harefield NHS Trust, London, UK
| | - Liam Smeeth
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Krishnan Bhaskaran
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Choi SH, Kim KE, Park Y, Ju YW, Jung JG, Lee ES, Lee HB, Han W, Noh DY, Yoon HJ, Moon HG. Effects of tamoxifen and aromatase inhibitors on the risk of acute coronary syndrome in elderly breast cancer patients: An analysis of nationwide data. Breast 2020; 54:25-30. [PMID: 32890789 PMCID: PMC7481564 DOI: 10.1016/j.breast.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Aromatase inhibitors (AIs) are the preferred endocrine treatment for postmenopausal hormonal receptor-positive breast cancer. However, there is controversy on the long-term cardiovascular and cerebrovascular safety of AIs over that of tamoxifen. Methods We analyzed the National Health Information Database (NHID) of 281,255 women over a 20-year-old diagnosed with breast cancer between 2009 and 2016. Cardiovascular events (CVEs) were defined as the development of the following, acute coronary syndrome (ACS), ischemic and hemorrhagic stroke, defined by using insurance claim records. The model was constructed by Cox proportional hazard regression and this model was used to analyze the effects of AI and tamoxifen on CVE. Results We included 47,569 women for the final analysis. Patients were classified into ‘No hormonal treatment (n = 18,807), ‘Switch (n = 2097)’, ‘Tamoxifen (n = 7081)’ and ‘AI (n = 19,584)’. There were 2147 CVEs in 2032 patients (4.1%). Univariate analysis showed that women with tamoxifen had significantly lower risk for CVEs compared to no-treatment (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.97) while AI showed no such effect (HR 0.93, 95% CI 0.84–1.02). After adjusting for other risk factors (hypertension, dyslipidemia, family history), the use of tamoxifen was associated with significant protective effect against ACS (HR 0.63, 95% CI 0.47–0.84). Conclusions Our results, based on the NHID, supports the protective effect of tamoxifen against CVE in Korean breast cancer patients aged 55 and older that is not seen with AIs. Our results can guide the selection of adjuvant hormonal treatment agents for Korean breast cancer patients based on their risk of developing CVE. Controversy on the long-term cardiovascular and cerebrovascular safety of AIs over that of tamoxifen. The protective effect of tamoxifen against cardiovascular events in elderly breast cancer patients that is not seen with AIs. Choice of hormonal therapy depends on patient’s cardiovascular or cerebrovascular risks.
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Affiliation(s)
- Sung Hyouk Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Kyoung-Eun Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Yujin Park
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Young Wook Ju
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Ji-Gwang Jung
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Eun Shin Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea; Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea; Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea; Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, Republic of Korea.
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Yandrapalli S, Malik AH, Pemmasani G, Gupta K, Harikrishnan P, Nabors C, Aronow WS, Cooper HA, Panza JA, Frishman WH, Jain D. Risk Factors and Outcomes During a First Acute Myocardial Infarction in Breast Cancer Survivors Compared with Females Without Breast Cancer. Am J Med 2020; 133:444-451. [PMID: 31715170 DOI: 10.1016/j.amjmed.2019.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this research was to study the differences in epidemiology and outcomes of a first myocardial infarction in breast cancer survivors compared with the general female population in the United States. METHODS We retrospectively analyzed the US National Inpatient Sample years 2005-2015 to identify adult women with a first myocardial infarction. In this cohort, breast cancer survivors were identified. Outcomes evaluated were the differences in baseline demographics, comorbidities, and adjusted in-hospital mortality in women with and without breast cancer. RESULTS Among 1,644,032 first myocardial infarction cases in adult women, there were 56,842 (3.5%) breast cancer survivors. Compared with women without breast cancer, breast cancer survivors were 6 years older (mean age 77 vs 71 years, P < .001), had significantly higher prevalence of dyslipidemia and hypertension, and lower prevalence of obesity, diabetes mellitus, and smoking. Breast cancer survivors were more likely to have a non-ST segment elevation acute myocardial infarction and less likely to receive mechanical revascularization. In-hospital mortality was lower in breast cancer survivors (7.1%) compared with those without (7.9%, P < .001), findings that persisted after risk adjustment (odds ratio 0.89; 95% CI, 0.82-0.94). CONCLUSIONS Breast cancer survivors had a first acute myocardial infarction at an older age and had small but favorable differences in cardiovascular disease risk factors and outcomes compared with women without breast cancer. The favorable impact of health education, preventative medical care, greater motivation for a healthier lifestyle, and participation in cancer survivorship programs on these seemingly paradoxical findings in breast cancer survivors should be further explored.
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Affiliation(s)
| | - Aaqib H Malik
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY
| | | | | | | | - Christopher Nabors
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY
| | | | | | | | - William H Frishman
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY
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Cheung YM, Ramchand SK, Yeo B, Grossmann M. Cardiometabolic Effects of Endocrine Treatment of Estrogen Receptor-Positive Early Breast Cancer. J Endocr Soc 2019; 3:1283-1301. [PMID: 31259291 PMCID: PMC6595530 DOI: 10.1210/js.2019-00096] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/01/2019] [Indexed: 12/15/2022] Open
Abstract
Estrogen receptor-positive early breast cancer is common and has a relatively good prognosis. It shares risk factors with cardiovascular disease, and cardiovascular disease is an important competing cause of mortality. Adjuvant endocrine therapy with aromatase inhibitors (requiring concomitant ovarian suppression in premenopausal women) or selective estrogen receptor modulators (usually tamoxifen) exert oncologic benefits by respectively inhibiting estradiol synthesis or breast estrogen receptor signaling. Aromatase inhibitors cause systemic estradiol depletion. Tamoxifen has mixed agonistic/antagonistic effects in a tissue-dependent fashion. Given that estrogens modulate cardiometabolic risk, a review of the effects of endocrine therapy on cardiometabolic outcomes is pertinent. The current, but limited, evidence suggests that tamoxifen treatment, although associated with increases in body fat, hepatic steatosis, serum triglycerides, and diabetes risk, modestly reduces low-density lipoprotein cholesterol and lipoprotein(a) and may have favorable effects on markers of subclinical atherosclerosis. Tamoxifen is associated with either no effect on, or a reduction in, cardiovascular events, and it is associated with an increase in venous thromboembolic events. Aromatase inhibitors, although fewer studies are available and often confounded by comparison with tamoxifen, have not been consistently associated with adverse changes in cardiometabolic risk factors or increases in cardiovascular events. Further clinical trials designed to evaluate cardiometabolic outcomes are needed to more accurately determine the effects of endocrine therapy on cardiovascular risks, to inform individualized decisions regarding choice and duration of endocrine therapy, and to implement evidence-based strategies to mitigate cardiometabolic risks. In the meantime, although breast cancer-specific evidence for benefit of lifestyle measures is available and recommended routinely, proactive monitoring and treatment of cardiovascular risk factors should follow general population recommendations.
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Affiliation(s)
- Yee-Ming Cheung
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria Australia
| | - Sabashini K Ramchand
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria Australia
| | - Belinda Yeo
- Department of Medical Oncology, Austin Health, Heidelberg, Victoria, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria Australia
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Matthews A, Stanway S, Farmer RE, Strongman H, Thomas S, Lyon AR, Smeeth L, Bhaskaran K. Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review. BMJ 2018; 363:k3845. [PMID: 30297439 PMCID: PMC6174332 DOI: 10.1136/bmj.k3845] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the effect of endocrine therapies on a wide range of specific clinical cardiovascular disease outcomes in women with a history of non-metastatic breast cancer. DESIGN Systematic review and meta-analysis of randomised controlled trials and observational studies. DATA SOURCES Medline and Embase up until June 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they investigated the risk of a specific cardiovascular disease outcome associated with use of either tamoxifen or an aromatase inhibitor, or compared the two treatments, in women with a history of non-metastatic breast cancer. APPRAISAL AND DATA EXTRACTION Relevant studies were originally identified and results extracted by one researcher, with a full replication of the study identification process by a combination of two other researchers. The Cochrane Collaboration's tool for assessing risk of bias was used to assess risk of bias in randomised controlled trials, and this tool was adapted to assess risk of bias in observational studies. RESULTS 26 studies were identified, with results for seven specific cardiovascular disease outcomes (venous thromboembolism, myocardial infarction, stroke, angina, heart failure, arrhythmia, and peripheral vascular disease). Results suggested an increased risk of venous thromboembolism in tamoxifen users compared with both non-users and aromatase inhibitor users. Results were also consistent with a higher risk of the vascular diseases myocardial infarction and angina in aromatase inhibitor users compared with tamoxifen users, but there was also a suggestion that this may be partly driven by a protective effect of tamoxifen on these outcomes. Data were limited, and evidence was generally inconsistent for all other cardiovascular disease outcomes. CONCLUSION This review has collated substantial randomised controlled trial and observational evidence on the effect of endocrine therapies on several specific cardiovascular disease outcomes including venous thromboembolism and myocardial infarction, progressing knowledge. Although the choice of aromatase inhibitor or tamoxifen will primarily be based on the effectiveness against the recurrence of breast cancer, this review shows that the individual patient's risk of venous or arterial vascular disease should be an important secondary consideration. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017065944.
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Affiliation(s)
- Anthony Matthews
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ruth E Farmer
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Strongman
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sara Thomas
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander R Lyon
- Faculty of Medicine, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Akyol M, Alacacioglu A, Demir L, Kucukzeybek Y, Yildiz Y, Gumus Z, Kara M, Salman T, Varol U, Taskaynatan H, Oflazoglu U, Bayoglu V, Tarhan MO. The alterations of serum FGF-21 levels, metabolic and body composition in early breast cancer patients receiving adjuvant endocrine therapy. Cancer Biomark 2018; 18:441-449. [PMID: 28106545 DOI: 10.3233/cbm-161507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In early breast cancer patients, the effects of hormonal therapy (tamoxifen and aromatase inhibitors) on plasma fibroblast growth factor 21 (FGF-21), lipid levels and body composition have not yet been investigated. Therefore, we aimed to analyze the relationship between FGF-21 and body composition as well as the effects of tamoxifen and aromatase inhibitors on plasma lipid levels, FGF-21, and body composition. METHODS A total of 72 patients were treated with either tamoxifen or aromatase inhibitors due to their menopausal status after adjuvant radiotherapy. Each patient was followed-up over a period of 1 year. Changes in body composition and serum lipid profile, glucose and FGF-21 levels were evaluated. We recorded the type of hormonal therapy, body mass index, waist-to-hip ratio, lipid profile, and FGF-21 levels both at the beginning and after 12 months. RESULTS There was a statistically significant decrease in serum FGF-21 levels after 12 months of adjuvant endocrine therapy (46 ± 19.21 pg/ml vs. 30.99 ± 13.81 pg/ml, p< 0.001). Total body water (p< 0.001), serum glucose (p= 0.036) and triglyceride levels (p< 0.001) also exhibited a significant decrease. The decreases in total cholesterol and low-density lipoprotein were not statistically significant. Likewise, high-density lipoprotein increased after adjuvant endocrine therapy, although it did not reach statistical significance. The changes in body composition, glucose, lipid profile and FGF-21 were similar in tamoxifen and aromatase inhibitor groups. A positive correlation was found between basal weight, fat mass, fat-free mass and serum FGF-21 levels; however, the correlation was maintained only for the fat-free mass at the 12th month. CONCLUSION As part of the present study, we suggest that both tamoxifen and aromatase inhibitors can reduce FGF-21 levels independently of body compositions, and these drugs can provide antihyperlipidemic, antidiabetic and cardio-protective effects. We also recommend that serum FGF-21 level can be utilized as a tumor biomarker in early-stage breast cancer and for monitoring purposes. FGF-21 levels may help physicians estimate prognosis, too. Further studies with larger populations may shed light on the role of FGF-21 in breast cancer.
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Affiliation(s)
- Murat Akyol
- Department of Medical Oncology, Manisa State Hospital, Manisa, Turkey
| | - Ahmet Alacacioglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Leyla Demir
- Department of Biochemistry, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yuksel Kucukzeybek
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yasar Yildiz
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zehra Gumus
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Mete Kara
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Tarik Salman
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Varol
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Halil Taskaynatan
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Utku Oflazoglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Vedat Bayoglu
- Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Li F, Wong TY, Lin SM, Chow S, Cheung WH, Chan FL, Chen S, Leung LK. Coadministrating luteolin minimizes the side effects of the aromatase inhibitor letrozole. J Pharmacol Exp Ther 2014; 351:270-7. [PMID: 25138022 DOI: 10.1124/jpet.114.216754] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aromatase inhibitors (AIs) have been used as adjuvant therapeutic agents for breast cancer. Their adverse side effect on blood lipid is well documented. Some natural compounds have been shown to be potential AIs. In the present study, we compared the efficacy of the flavonoid luteolin to the clinically approved AI letrozole (Femara; Novartis Pharmaceuticals, East Hanover, NJ) in a cell and a mouse model. In the in vitro experimental results for aromatase inhibition, the Ki values of luteolin and letrozole were estimated to be 2.44 µM and 0.41 nM, respectively. Both letrozole and luteolin appeared to be competitive inhibitors. Subsequently, an animal model was used for the comparison. Aromatase-expressing MCF-7 cells were transplanted into ovariectomized athymic mice. Luteolin was given by mouth at 5, 20, and 50 mg/kg, whereas letrozole was administered by intravenous injection. Similar to letrozole, luteolin administration reduced plasma estrogen concentrations and suppressed the xenograft proliferation. The regulation of cell cycle and apoptotic proteins-such as a decrease in the expression of Bcl-xL, cyclin-A/D1/E, CDK2/4, and increase in that of Bax-was about the same in both treatments. The most significant disparity was on blood lipids. In contrast to letrozole, luteolin increased fasting plasma high-density lipoprotein concentrations and produced a desirable blood lipid profile. These results suggested that the flavonoid could be a coadjuvant therapeutic agent without impairing the action of AIs.
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Affiliation(s)
- Fengjuan Li
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Tsz Yan Wong
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Shu-mei Lin
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Simon Chow
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Wing-hoi Cheung
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Franky L Chan
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Shiuan Chen
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
| | - Lai K Leung
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China (F.L.); Biochemistry Programme, School of Life Sciences, Faculty of Science (F.L), Food and Nutritional Sciences Programme , School of Life Sciences, Faculty of Science (T.Y.W., L.K.L.), Department of Orthopaedics and Traumatology, Faculty of Medicine (Si.C., W.C.), and School of Biomedical Sciences, Faculty of Medicine (F.L.C.), The Chinese University of Hong Kong, Shatin, Hong Kong; Department of Food Science, National Chiayi University, Chiayi City, Taiwan, Republic of China (S.L.); and Department of Cancer Biology, Beckman Research Institute of the City of Hope, Duarte, California (Sh.C.)
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Lin C, Chen LS, Kuo SJ, Chen DR. Adjuvant tamoxifen influences the lipid profile in breast cancer patients. ACTA ACUST UNITED AC 2014; 9:35-9. [PMID: 24803885 DOI: 10.1159/000358752] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Currently there is a debate regarding whether tamoxifen used in breast cancer has an impact on lipid profiles. The aim of this study was to determine whether tamoxifen has an impact on the serum lipid profile in Taiwanese women. PATIENTS AND METHODS Data of 109 patients were collected from the routine clinical follow-up for women with hormone receptor-positive breast cancer who were treated between July 2005 and March 2008. These patients were divided into 2 subgroups, based on their tumor grade and lymph node status. Subgroup 1 patients had tumor grade I/II and a negative lymph node status. Those patients with tumor grade III or a positive lymph node status were defined as subgroup 2. RESULTS In the 109 patients, the mean serum total cholesterol (TC) levels after tamoxifen treatment, as well as the serum low-density lipoprotein cholesterol (LDL-C) levels, were lower than the baseline levels, with statistically significant differences. Treatment with tamoxifen lowered the serum TC and LDL-C levels in both subgroups. CONCLUSIONS The results indicate that tamoxifen has an impact on the serum lipid profile of breast cancer patients in Taiwan. Physicians should follow up the lipid profile in these patients.
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Affiliation(s)
- Che Lin
- Department of Research, Changhua Christian Hospital, Changhua, R.O.C. ; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, R.O.C. ; Department of Environmental Engineering, National Chung-Hsing University, Taichung, R.O.C
| | - Li-Sheng Chen
- Center of Biostatistics Consultation, College of Public Health, National Taiwan University, Taipei, R.O.C. ; School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, R.O.C
| | - Shou-Jen Kuo
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, R.O.C. ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Dar-Ren Chen
- Department of Research, Changhua Christian Hospital, Changhua, R.O.C. ; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, R.O.C. ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
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11
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Kemp A, Preen DB, Saunders C, Boyle F, Bulsara M, Holman CDJ, Malacova E, Roughead EE. Women commencing anastrozole, letrozole or tamoxifen for early breast cancer: the impact of comorbidity and demographics on initial choice. PLoS One 2014; 9:e84835. [PMID: 24392158 PMCID: PMC3879327 DOI: 10.1371/journal.pone.0084835] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022] Open
Abstract
Background Australian clinical guidelines recommend endocrine therapy for all women with hormone-dependent early breast cancer. Guidelines specify tamoxifen as first-line therapy for pre-menopausal women, and tamoxifen or an aromatase inhibitor (AI) for post-menopausal women depending on the risk of recurrence based on tumour characteristics including size. Therapies have different side effect profiles; therefore comorbidity may also influence choice. We examined comorbidity, and the clinical and demographic characteristics of women commencing different therapies. Patients and Methods We identified the first dispensing of tamoxifen, anastrozole or letrozole for women diagnosed with invasive breast cancer in the 45 and Up Study from 2004–2009 (N = 1266). Unit-level pharmacy and medical service claims, hospital, Cancer Registry, and self-reported data were linked to determine menopause status at diagnosis, tumour size, age, comorbidities, and change in subsidy restrictions. Chi-square tests and generalised regression models were used to compare the characteristics of women commencing different therapies. Results Most pre-menopausal women commenced therapy with tamoxifen (91%). Anastrozole was the predominant therapy for post-menopausal women (57%), followed by tamoxifen (28%). Women with osteoporosis were less likely to commence anastrozole compared with tamoxifen (anastrozole RR = 0.7, 95% CI = 0.5–0.9). Women with arthritis were 1.6-times more likely to commence letrozole than anastrozole (95% CI = 1.1–2.1). Tamoxifen was more often initiated in women with tumours >1 cm, who were also ≥75 years. Subsidy restriction changes were associated with substantial increases in the proportion of women commencing AIs (anastrozole RR = 4.3, letrozole RR = 8.3). Conclusions The findings indicate interplay of comorbidity and therapy choice for women with invasive breast cancer. Most post-menopausal women commenced therapy with anastrozole; however, letrozole and tamoxifen were more often initiated for women with comorbid arthritis and osteoporosis, respectively. Tamoxifen was also more common for women with tumours >1 cm and aged ≥75 years. Subsidy restrictions appear to have strongly influenced therapy choice.
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Affiliation(s)
- Anna Kemp
- Centre for Health Services Research, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - David B. Preen
- Centre for Health Services Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
| | - Frances Boyle
- Patricia Richie Centre for Cancer Care and Research, The Mater Hospital, Sydney, New South Wales, Australia
| | - Max Bulsara
- Institute of Health Research, University of Notre Dame, Perth, Western Australia, Australia
| | - C. D’Arcy J. Holman
- Centre for Health Services Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Eva Malacova
- Centre for Health Services Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth E. Roughead
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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12
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Kim SH, Lee MR, Lee KC, Lee JH, Kwon HC, Kim DC, Lee KW, Cho SH. Use of Antidepressants in Patients with Breast Cancer Taking Tamoxifen. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.4.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seong Hwan Kim
- Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea
| | - Mi-Ri Lee
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Keun-Cheol Lee
- Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jin-Hwa Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Hyuk-Chan Kwon
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dae-Cheol Kim
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Woo Lee
- Department of Rehabilitation Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Se-Heon Cho
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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