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Howell A, Ashcroft L, Fallowfield L, Eccles DM, Eeles RA, Ward A, Brentnall AR, Dowsett M, Cuzick JM, Greenhalgh R, Boggis C, Motion J, Sergeant JC, Adams J, Evans DG. RAZOR: A Phase II Open Randomized Trial of Screening Plus Goserelin and Raloxifene Versus Screening Alone in Premenopausal Women at Increased Risk of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:58-66. [PMID: 29097444 DOI: 10.1158/1055-9965.epi-17-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/16/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Ovarian suppression in premenopausal women is known to reduce breast cancer risk. This study aimed to assess uptake and compliance with ovarian suppression using the luteinizing hormone releasing hormone (LHRH) analogue, goserelin, with add-back raloxifene, as a potential regimen for breast cancer prevention.Methods: Women at ≥30% lifetime risk breast cancer were approached and randomized to mammographic screening alone (C-Control) or screening in addition to monthly subcutaneous injections of 3.6 mg goserelin and continuous 60 mg raloxifene daily orally (T-Treated) for 2 years. The primary endpoint was therapy adherence. Secondary endpoints were toxicity/quality of life, change in bone density, and mammographic density.Results: A total of 75/950 (7.9%) women approached agreed to randomization. In the T-arm, 20 of 38 (52%) of women completed the 2-year period of study compared with the C-arm (27/37, 73.0%). Dropouts were related to toxicity but also the wish to have established risk-reducing procedures and proven chemoprevention. As relatively few women completed the study, data are limited, but those in the T-arm reported significant increases in toxicity and sexual problems, no change in anxiety, and less cancer worry. Lumbar spine bone density declined by 7.0% and visually assessed mammographic density by 4.7% over the 2-year treatment period.Conclusions: Uptake is somewhat lower than comparable studies with tamoxifen for prevention with higher dropout rates. Raloxifene may preserve bone density, but reduction in mammographic density reversed after treatment was completed.Impact: This study indicates that breast cancer risk reduction may be possible using LHRH agonists, but reducing toxicity and preventing bone changes would make this a more attractive option. Cancer Epidemiol Biomarkers Prev; 27(1); 58-66. ©2017 AACR.
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Affiliation(s)
- Anthony Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Linda Ashcroft
- Trials Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Diana M Eccles
- Faculty of Medicine, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom
| | - Rosalind A Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Ann Ward
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Adam R Brentnall
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Mitchell Dowsett
- Department of Academic Biochemistry, Institute of Cancer Research, London, United Kingdom
| | - Jack M Cuzick
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Rosemary Greenhalgh
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Caroline Boggis
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie Motion
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Judith Adams
- Department of Radiology, University of Manchester, Manchester, United Kingdom
| | - D Gareth Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom.
- Division of Evolution and Genomic Science, Department of Genomic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, The University of Manchester, St. Mary's Hospital, Manchester, United Kingdom
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Jain A, Kunduru KR, Basu A, Mizrahi B, Domb AJ, Khan W. Injectable formulations of poly(lactic acid) and its copolymers in clinical use. Adv Drug Deliv Rev 2016; 107:213-227. [PMID: 27423636 DOI: 10.1016/j.addr.2016.07.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
Poly(lactic acid) and its copolymers have revolutionized the field of drug delivery due to their excellent biocompatibility and tunable physico-chemical properties. These copolymers have served the healthcare sector by contributing many products to combat various diseases and for biomedical applications. This article provides a comprehensive overview of clinically used products of poly(lactic acid) and its copolymers. Multi-dimension information covering product approval, formulation aspects and clinical status is described to provide a panoramic overview of each product. Moreover, leading patented technologies and various clinical trials on these products for different applications are included. This review focuses on marketed injectable formulations of PLA and its copolymers.
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