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Yu K, Portes P, Morris GS, Huang L, Felix ER, Farkas GJ, Molinares D, Tiozzo E. The role of exercise in aromatase inhibitor-induced arthralgia. PM R 2024. [PMID: 38780410 DOI: 10.1002/pmrj.13193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
Aromatase inhibitors are prescribed in breast cancer due to their associated lower rate of cancer recurrence compared to tamoxifen. However, aromatase inhibitor-induced arthralgia (AIIA) is one of the leading causes of treatment nonadherence, increasing the risk of cancer recurrence. The pathophysiology of AIIA is poorly understood, and although current recommendations for AIIA include lifestyle changes and analgesics depending on the severity of symptoms, there is no established effective treatment. The aim of this study is to explore the presentation and mechanism of AIIA and investigate the feasibility and efficacy of different exercise interventions (aerobic, resistance, aerobic and resistance combined, and yoga or tai chi) in patients with AIIA to guide the development of formal exercise prescription guidelines. Findings indicate that a mixed-modality regimen of aerobic and resistance exercises is feasible and safe and may serve the most benefit in improving joint pain, functionality, and quality of life. More specifically, the weekly regimen should consist of 150 min of aerobic exercise with two sessions of at least six resistance exercises, 8 to 12 repetitions, three sets each. Supplementary yoga and tai chi may be recommended twice a week depending on a patient's target symptoms. Yoga was associated with improved physical functionality, whereas tai chi was related to improvements in mental health. However, the feasibility and impact of combined aerobic and resistance exercise protocols with yoga or tai chi in our target population were not investigated in this review. The use of large, randomized controlled trials is recommended for future studies.
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Affiliation(s)
- Kerstin Yu
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pauline Portes
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, North Carolina, USA
| | - Laura Huang
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
- Mount Vernon Rehabilitation Medicine Associates, Alexandria, Virginia, USA
| | - Elizabeth R Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gary J Farkas
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Diana Molinares
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eduard Tiozzo
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
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Doan LV, Yoon J, Chun J, Perez R, Wang J. Pain associated with breast cancer: etiologies and therapies. FRONTIERS IN PAIN RESEARCH 2023; 4:1182488. [PMID: 38148788 PMCID: PMC10750403 DOI: 10.3389/fpain.2023.1182488] [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: 05/08/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Pain associated with breast cancer is a prevalent problem that negatively affects quality of life. Breast cancer pain is not limited to the disease course itself but is also induced by current therapeutic strategies. This, combined with the increasing number of patients living with breast cancer, make pain management for breast cancer patients an increasingly important area of research. This narrative review presents a summary of pain associated with breast cancer, including pain related to the cancer disease process itself and pain associated with current therapeutic modalities including radiation, chemotherapy, immunotherapy, and surgery. Current pain management techniques, their limitations, and novel analgesic strategies are also discussed.
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Affiliation(s)
- Lisa V. Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jenny Yoon
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jeana Chun
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Raven Perez
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience and Physiology, NYU Grossman School of Medicine, New York, NY, United States
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3
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Fialho MFP, Brum ES, Becker G, Brusco I, Oliveira SM. Kinin B2 and B1 Receptors Activation Sensitize the TRPA1 Channel Contributing to Anastrozole-Induced Pain Symptoms. Pharmaceutics 2023; 15:pharmaceutics15041136. [PMID: 37111622 PMCID: PMC10143169 DOI: 10.3390/pharmaceutics15041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Aromatase inhibitors (AIs) cause symptoms of musculoskeletal pain, and some mechanisms have been proposed to explain them. However, signaling pathways downstream from kinin B2 (B2R) and B1 (B1R) receptor activation and their possible sensitizing of the Transient Receptor Potential Ankyrin 1 (TRPA1) remain unknown. The interaction between the kinin receptor and the TRPA1 channel in male C57BL/6 mice treated with anastrozole (an AI) was evaluated. PLC/PKC and PKA inhibitors were used to evaluate the signaling pathways downstream from B2R and B1R activation and their effect on TRPA1 sensitization. Anastrozole caused mechanical allodynia and muscle strength loss in mice. B2R (Bradykinin), B1R (DABk), or TRPA1 (AITC) agonists induced overt nociceptive behavior and enhanced and prolonged the painful parameters in anastrozole-treated mice. All painful symptoms were reduced by B2R (Icatibant), B1R (DALBk), or TRPA1 (A967079) antagonists. We observed the interaction between B2R, B1R, and the TRPA1 channel in anastrozole-induced musculoskeletal pain, which was dependent on the activation of the PLC/PKC and PKA signaling pathways. TRPA1 seems to be sensitized by mechanisms dependent on the activation of PLC/PKC, and PKA due to kinin receptors stimulation in anastrozole-treated animals. Thus, regulating this signaling pathway could contribute to alleviating AIs-related pain symptoms, patients’ adherence to therapy, and disease control.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Gabriela Becker
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Indiara Brusco
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
- Department of Biochemical and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
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4
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Small T, Fox K, Edge L, Harker J. Total Hip Arthroplasty With Prophylactic Fixation of Greater Trochanter and Distal Femur in a Patient With a History of Multiple Myeloma and Breast Cancer. Cureus 2023; 15:e37971. [PMID: 37223142 PMCID: PMC10202678 DOI: 10.7759/cureus.37971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Multiple myeloma is the most common primary malignancy of the bone marrow and may present as bone pain and/or pathologic fracture(s) in affected patients. Treatment of bone lesions typically consists of chemotherapy and radiation and may include prophylactic fixation in patients meeting specific criteria. This report reviews a case of a 74-year-old female with a history of multiple myeloma and breast cancer, previously treated with chemotherapy and radiation, who sustained a pathologic femoral neck fracture with associated ipsilateral lesions of the femoral shaft and peritrochanteric region. This patient received a total hip arthroplasty with a greater trochanteric claw plate and extended femoral stem for prophylactic fixation of the distal femur. In this report, the current literature surrounding the use of extended femoral stems for prophylactic fixation of femoral diaphyseal lesions will be reviewed and the above case will be presented. This case serves as a bridge between orthopedic oncology and arthroplasty as an extended femoral stem was used to prevent future pathologic fracture of distal femur lesions.
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Affiliation(s)
- Tyler Small
- Orthopaedic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Kevin Fox
- Orthopaedic Surgery, HCA Healthcare/USF Morsani College of Medicine GME: HCA Florida Largo Hospital, Largo, USA
| | - Lauren Edge
- Orthopaedic Surgery, HCA Healthcare/USF Morsani College of Medicine GME: HCA Florida Largo Hospital, Largo, USA
| | - John Harker
- Orthopaedic Surgery, HCA Healthcare/USF Morsani College of Medicine GME: HCA Florida Largo Hospital, Largo, USA
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Bluethmann SM, Flores E, Grotte M, Heitzenrater J, Truica CI, Olsen NJ, Sciamanna C, Schmitz KH. Adapting an Evidence-Based Exercise and Education Program for Older Breast Cancer Survivors for the REJOIN Trial. J Aging Phys Act 2023; 31:59-67. [PMID: 35700977 PMCID: PMC10903157 DOI: 10.1123/japa.2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
Abstract
Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Eileen Flores
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
| | - Meghan Grotte
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Jared Heitzenrater
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Cristina I Truica
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Nancy J Olsen
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA,USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,USA
- Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA,USA
- Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, Hershey, PA,USA
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Rassy E, Bardet A, Bougacha O, Gantzer L, Lekens B, Delaloge S, André F, Michiels S, Pistilli B. Association of Adherence to Endocrine Therapy Among Patients With Breast Cancer and Potential Drug-Drug Interactions. JAMA Netw Open 2022; 5:e2244849. [PMID: 36459136 PMCID: PMC9719053 DOI: 10.1001/jamanetworkopen.2022.44849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Suboptimal adherence to endocrine therapy (ET) among patients with hormone-receptor-positive breast cancer significantly affects survival outcomes and is associated with higher hospitalization rates and health care costs. Weak adherence to long-term treatments has multiple determinants, including disease characteristics, treatment adverse effects, and patients' attributes, such as age and comorbidities. OBJECTIVE To examine whether potential drug-drug interactions (PDDI) with tamoxifen or aromatase inhibitor were associated with adherence to ET in patients with early and advanced breast cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study used anonymized health record data of women with breast cancer who received ET in a private observational primary care database. Patients eligible for analysis included women aged 18 years or older who had a reported diagnosis of breast cancer and received ET with tamoxifen or aromatase inhibitor between 1994 and 2021. Data were analyzed 2021. EXPOSURES Adherence to ET during a given year was defined by a medication possession ratio of 80% or greater over 1-year prescription periods. PDDI were categorized into absent, minor (a combination to take into account), moderate (combination requiring precautions for use), major (combination not recommended), and contraindicated according to guidelines in the Claude Bernard Drug Database. MAIN OUTCOMES AND MEASURES We used regression models to estimate odds ratios (ORs) and 95% CIs for the associations between adherence and age, baseline comorbidities, PDDI, and adherence to ET during the previous year. RESULTS A total of 10 863 patients who were prescribed ET for breast cancer were eligible for the analysis (age 70 years or older, 3509 patients [32.3%]). In the tamoxifen cohort (3564 patients), PDDI were reported in 497 of 3670 patients (13.5%) at baseline (moderate, 254 patients [51.1%]; major, 227 patients [45.7%]), 2047 of 4831 patients (42.4%) at year 1, 1127 of 2751 patients (41.0%) at year 2, 761 of 1861 patients (40.9%) at year 3, 376 of 1058 patients (35.5%) at year 4, and 201 of 593 patients (33.9%) at year 5. In the aromatase inhibitor cohort (7299 patients), PDDI were reported in 592 of 7437 patients (8.0%) at baseline (moderate in 588 of 592 patients [99.3%]), which reached 2875 of 9031 patients (31.8%) at year 1 and ranged between 31.4% (1802 of 5730 patients in year 2) and 32.8% (791 of 2411 in year 4) throughout the study period. No association between adherence and PDDI was found in the tamoxifen (OR, 0.99; 95% CI, 0.91-1.08) or aromatase inhibitor (OR, 1.05; 95% CI, 0.95-1.15) cohort. CONCLUSIONS AND RELEVANCE In this cohort of patients with hormone-receptor-positive breast cancer, PDDI with tamoxifen and aromatase inhibitors were not associated with adherence to ET.
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Affiliation(s)
- Elie Rassy
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Aurélie Bardet
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Omar Bougacha
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Laurène Gantzer
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Béranger Lekens
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
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Marsden J. The British menopause society consensus statement on the management of oestrogen deficiency symptoms, arthralgia and menopause diagnosis in women with treated for early breast cancer. Post Reprod Health 2022; 28:199-210. [PMID: 36050892 DOI: 10.1177/20533691221122358] [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: 11/15/2022]
Abstract
This guidance document by the British Menopause Society provides an overview of the management of women experiencing oestrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended breast cancer patients are referred to health care professionals with an expertise in menopause for management of such symptoms, which in turn often involves liaison with patients' breast cancer teams.1 However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points. This is an updated version of the 2018 consensus statement prepared by Miss Jo Marsden Consultant Breast Surgeon, King's College Hospital, London, (retired), Mr Mike Marsh, Consultant Gynae-endocrinologist, King's College Hospital, London, Dr Anne Rigg, Consultant Medical Oncologist, Guy's and St Thomas' Hospital, London.
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Affiliation(s)
- Jo Marsden
- 8948King's College Hospital NHS Foundation Trust, London, UK
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8
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Bassatne A, Bou Khalil A, Chakhtoura M, Arabi A, Van Poznak C, El-Hajj Fuleihan G. Effect of antiresorptive therapy on aromatase inhibitor induced bone loss in postmenopausal women with early-stage breast cancer: A systematic review and meta-analysis of randomized controlled trials. Metabolism 2022; 128:154962. [PMID: 34958816 DOI: 10.1016/j.metabol.2021.154962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/30/2021] [Accepted: 12/14/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are routinely used to treat postmenopausal women with early-stage breast cancer. Although AIs improve breast cancer outcomes, they increase the risk of osteoporosis and fractures. This systematic review and meta-analysis assesses the effect of antiresorptive drugs on AI induced bone loss in postmenopausal women with non-metastatic breast cancer. METHODS We searched four databases until November 4th 2020. We included Randomized controlled trials (RCTs) of antiresorptive drugs in postmenopausal women with breast cancer treated with AI. Two authors screened studies, extracted data and assessed the risk of bias independently and in duplicate. RESULTS We identified 14 RCTs: 7 on zoledronic acid, 6 on oral bisphosphonates and 1 on denosumab. The mean difference in bone mineral density (BMD) was 5% at the lumbar spine and 4% at the total hip, at 12 months, favoring zoledronic acid compared to control. The certainty of the evidence was low for lumbar spine and moderate for total hip BMD. Similarly, the mean difference was 3% at the lumbar spine and 2% at the total hip, favoring oral bisphosphonates with moderate certainty. The mean difference was 6% at the lumbar spine, and 4% at the total hip BMD favoring denosumab compared to placebo. In addition, zoledronic acid resulted in a mean difference in bone turnover marker levels of -35-41%, and the relarive risk for morphometric vertebral fractures was 0.7 [0.3-1.4], compared to control. Denosumab reduced fracture incidence by 50% compared to placebo. CONCLUSION Evidence suggests a protective effect of antiresorptive drugs on BMD and bone turnover markers in postmenopausal women with non-metastatic breast cancer on AI. However, data on fracture risk reduction remains unclear.
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Affiliation(s)
- Aya Bassatne
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abir Bou Khalil
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asma Arabi
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology and Metabolism, WHO Collaborating Center in Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Feasibility Trial to Evaluate Tendon Stiffness Obtained from Shear Wave Elastography Imaging as a Biomarker of Aromatase Inhibitor-Induced Arthralgias. J Clin Med 2022; 11:jcm11041067. [PMID: 35207339 PMCID: PMC8875194 DOI: 10.3390/jcm11041067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023] Open
Abstract
Aromatase inhibitor-induced arthralgia (AIA) comprises significant, activity-limiting musculoskeletal symptoms, including joint pain, myalgia, and joint stiffness. We conducted a prospective feasibility study in postmenopausal women diagnosed with early-stage (0–3) hormone receptor positive (HR+) breast cancer who were candidates for treatment with adjuvant AI therapy (n = 16). Tendons of the hands and wrists and the median nerve were imaged using gray-scale and power Doppler ultrasound (US) and US SWE. Arthralgia symptoms were evaluated using the Breast Cancer Prevention Trial (BCPT) Symptom Checklist musculoskeletal subscale (MS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness subscales. At baseline, there were significant differences in the SW velocities of tendons between dominant and nondominant hands. Increased velocity in 2 of 6 tendons and the median nerve was associated with greater pain at baseline, whereas slower velocity of the extensor digitorum tendon (suggesting decreased stiffness) was associated with a higher WOMAC stiffness score. Increased SW velocity (suggestive of increased stiffness) at baseline in the abductor pollicis longus tendon was associated with a worsening of all three pain and stiffness measures by 6 months. Future studies should evaluate SWE scores related to AIA outcomes in a larger sample size.
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Trivedi T, Guise TA. Systemic effects of abnormal bone resorption on muscle, metabolism, and cognition. Bone 2022; 154:116245. [PMID: 34718221 DOI: 10.1016/j.bone.2021.116245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
Skeletal tissue is dynamic, undergoing constant remodeling to maintain musculoskeletal integrity and balance in the human body. Recent evidence shows that apart from maintaining homeostasis in the local microenvironment, the skeleton systemically affects other tissues. Several cancer-associated and noncancer-associated bone disorders can disrupt the physiological homeostasis locally in the bone microenvironment and indirectly contribute to dysregulation of systemic body function. The systemic effects of bone on the regulation of distant organ function have not been widely explored. Recent evidence suggests that bone can interact with skeletal muscle, pancreas, and brain by releasing factors from mineralized bone matrix. Currently available bone-targeting therapies such as bisphosphonates and denosumab inhibit bone resorption, decrease morbidity associated with bone destruction, and improve survival. Bisphosphonates have been a standard treatment for bone metastases, osteoporosis, and cancer treatment-induced bone diseases. The extraskeletal effects of bisphosphonates on inhibition of tumor growth are known. However, our knowledge of the effects of bisphosphonates on muscle weakness, hyperglycemia, and cognitive defects is currently evolving. To be able to identify the molecular link between bone and distant organs during abnormal bone resorption and then treat these abnormalities and prevent their systemic effects could improve survival benefits. The current review highlights the link between bone resorption and its systemic effects on muscle, pancreas, and brain.
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Affiliation(s)
- Trupti Trivedi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Theresa A Guise
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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Gaudio A, Xourafa A, Rapisarda R, Castellino P. Therapeutic Options in the Management of Aromatase Inhibitor-Associated Bone Loss. Endocr Metab Immune Disord Drug Targets 2021; 22:259-273. [PMID: 34370654 DOI: 10.2174/1871530321666210809153152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer in women worldwide. Early breast cancer is a kind of invasive neoplasm that has not proliferated beyond the breast or the axillary lymph nodes. Current therapeutic strategies for breast cancer mainly include local therapies such as surgery or radiotherapy and systemic therapies like chemotherapy, endocrine, and targeted therapy.Nowadays, the adjuvant treatment for hormone receptor-positive early breast cancer in postmenopausal women remains the main effective systemic therapy which can improve disease-free survival and overall survival; it involves several endocrine treatment regimens including selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), or a combination of them. AIs have been shown to be more effective in preventing recurrence in postmenopausal women with early breast cancer when compared with tamoxifen, thus representing the standard of care for adjuvant endocrine therapy. Although AIs are usually well-tolerated, they can have some side effects. Apart from the appearance of arthralgias or myalgias and cardiovascular events, AI therapies, reducing already low endogenous postmenopausal estradiol levels, cause increased bone loss and increase fracture risk in postmenopausal women. OBJECTIVES To evaluate the therapeutic options in the management of aromatase inhibitor-associated bone loss (AIBL). METHODS We reviewed the current literature dealing with different therapeutic options in the treatment of AIBL. RESULTS Clinical practice guidelines recommend a careful evaluation of skeletal health in all women with breast cancer before AI therapy initiation. Adequate calcium and vitamin D intake have also been suggested. Pharmacological attempts to minimize AI-related bone loss have focused on the use of antiresorptive agents, such as bisphosphonates and denosumab, to protect bone integrity and reduce the risk of fractures. Furthermore, clinical trials have shown that by making the bone microenvironment less susceptible to breast cancer metastasis, these drugs are able to increase disease-free survival. CONCLUSIONS AI, thatare the pillar of the systemic treatment for patients with hormone receptor-positive breast cancer, are associated with different side effects, and in particular osteoporosis and fractures. Both bisphosphonates and denosumab are able to prevent this negative effect.
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Affiliation(s)
- Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania , Italy
| | | | | | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania , Italy
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Invernizzi M, de Sire A, Venetis K, Cigna E, Carda S, Borg M, Cisari C, Fusco N. Quality of Life Interventions in Breast Cancer Survivors: State of the Art in Targeted Rehabilitation Strategies. Anticancer Agents Med Chem 2021; 22:801-810. [PMID: 34151769 DOI: 10.2174/1871520621666210609095602] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022]
Abstract
Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications, such as breast cancer-related lymphedema, axillary web syndrome, persistent pain, bone loss, arthralgia, and fatigue. These conditions have a detrimental impact on the health-related quality of life of survivors. Here, we sought to provide a portrait of the role that rehabilitation plays in breast cancer survivors. Particular emphasis has been placed on recovering function, improving independence in activities of daily living, and reducing disability. This complex scenario requires a precision medicine approach to provide more effective decision-making and adequate treatment compliance.
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Affiliation(s)
- Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | | | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne. Switzerland
| | - Margherita Borg
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Nicola Fusco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Collin A, Vein J, Wittrant Y, Pereira B, Amode R, Guillet C, Richard D, Eschalier A, Balayssac D. A new clinically-relevant rat model of letrozole-induced chronic nociceptive disorders. Toxicol Appl Pharmacol 2021; 425:115600. [PMID: 34081940 DOI: 10.1016/j.taap.2021.115600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/15/2021] [Accepted: 05/28/2021] [Indexed: 12/21/2022]
Abstract
Among postmenopausal women with estrogen receptor-positive breast cancer, more than 80% receive hormone therapy including aromatase inhibitors (AIs). Half of them develop chronic arthralgia - characterized by symmetric articular pain, carpal tunnel syndrome, morning stiffness, myalgia and a decrease in grip strength - which is associated with treatment discontinuation. Only a few animal studies have linked AI treatment to nociception, and none to arthralgia. Thus, we developed a new chronic AI-induced nociceptive disorder model mimicking clinical symptoms induced by AIs, using subcutaneous letrozole pellets in ovariectomized (OVX) rats. Following plasma letrozole dosage at the end of the experiment (day 73), only rats with at least 90 ng/ml of letrozole were considered significantly exposed to letrozole (OVX + high LTZ group), whereas treated animals with less than 90 ng/ml were pooled in the OVX + low LTZ group. Chronic nociceptive disorder set in rapidly and was maintained for more than 70 days in the OVX + high LTZ group. Furthermore, OVX + high LTZ rats saw no alteration in locomotion, myalgia or experimental anxiety during this period. Bone parameters of the femora were significantly altered in all OVX rats compared to Sham+vehicle pellet. A mechanistic analysis focused on TRPA1, receptor suspected to mediate AI-evoked pain, and showed no modification in its expression in the DRG. This new long-lasting chronic rat model, efficiently reproduces the symptoms of AI-induced nociceptive disorder affecting patients' daily activities and quality-of-life. It should help to study the pathophysiology of this disorder and to promote the development of new therapeutic strategies.
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Affiliation(s)
- Aurore Collin
- Université Clermont Auvergne, INSERM, U1107, NEURO-DOL, F-63000 Clermont-Ferrand, France.
| | - Julie Vein
- Université Clermont Auvergne, INSERM, U1107, NEURO-DOL, F-63000 Clermont-Ferrand, France
| | - Yohann Wittrant
- Université Clermont Auvergne, INRA, UNH, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, 63122 Saint-Genès Champanelle, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Direction de la recherche clinique et de l'innovation, F-63000 Clermont-Ferrand, France
| | - Raalib Amode
- School of Pharmacy, Faculty of Science, University of East Anglia, UK
| | - Christelle Guillet
- Université Clermont Auvergne, INRA, UMR1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France
| | - Damien Richard
- Université Clermont Auvergne, INSERM U1107, NEURO-DOL, CHU Clermont-Ferrand, Laboratoire de Pharmacologie et de Toxicologie, F-63000 Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, INSERM, U1107, NEURO-DOL, F-63000 Clermont-Ferrand, France
| | - David Balayssac
- Université Clermont Auvergne, INSERM U1107, NEURO-DOL, CHU Clermont-Ferrand, Direction de la recherche clinique et de l'innovation, F-63000 Clermont-Ferrand, France.
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Adhikari M, Delgado-Calle J. Role of Osteocytes in Cancer Progression in the Bone and the Associated Skeletal Disease. Curr Osteoporos Rep 2021; 19:247-255. [PMID: 33818732 PMCID: PMC8486016 DOI: 10.1007/s11914-021-00679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The goal of this manuscript is to review the current knowledge on the role of osteocytes in cancer in the bone, discuss the potential of osteocytes as a therapeutic target, and propose future research needed to understand the crosstalk between cancer cells and osteocytes in the tumor niche. RECENT FINDINGS Numerous studies have established that cancer cells manipulate osteocytes to facilitate invasion and tumor progression in bone. Moreover, cancer cells dysregulate osteocyte function to disrupt physiological bone remodeling, leading to the development of bone disease. Targeting osteocytes and their derived factors has proven to effectively interfere with the progression of cancer in the bone and the associated bone disease. Osteocytes communicate with cancer cells and are also part of the vicious cycle of cancer in the bone. Additional studies investigating the role of osteocytes on metastases to the bone and the development of drug resistance are needed.
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Affiliation(s)
- Manish Adhikari
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Jesús Delgado-Calle
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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15
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Bluethmann SM, Truica C, Klepin HD, Olsen N, Sciamanna C, Chinchilli VM, Schmitz KH. Study design and methods for the using exercise to relieve joint pain and improve AI adherence in older breast cancer survivors (REJOIN) trial. J Geriatr Oncol 2021; 12:1146-1153. [PMID: 34049837 DOI: 10.1016/j.jgo.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Aromatase Inhibitors (AIs) are recommended for survival in post-menopausal breast cancer survivors (BCS) with hormone-sensitive disease. AI Adherence is suboptimal, especially in older BCS. Joint pain is a common AI-related symptom that is associated with low AI adherence. The Using Exercise to Relieve Joint Pain in Older Breast Cancer Survivors (REJOIN) Trial will evaluate the efficacy of a self-management intervention (exercise + education) to increase knowledge/self-efficacy for symptom management, reduce joint pain and potentially increase AI adherence in older BCS planning to take AIs. METHODS This randomized controlled pilot trial will include sedentary BCS, 65 years and older, diagnosed with stage I-III hormone-sensitive breast cancer, who have completed primary cancer treatment and are planning to initiate AIs. We will adapt an evidence-based physical activity program for older adults that includes bi-weekly, supervised exercise sessions plus 30 min of education. The 16-week intervention program includes: 8-weeks of supervised sessions plus 8-weeks of self-guided home sessions with periodic phone coaching. We will conduct geriatric assessments plus measurements of exercise, joint pain, and AI adherence (baseline, 4, 6 and 12 months). DISCUSSION REJOIN is one of the first trials to exclusively target older BCS using a self-management intervention, informed by geriatric assessment and exercise physiology, to improve health outcomes in survivorship. The REJOIN trial could lay the foundation for transdisciplinary research that bridges the gap between clinical and public health perspectives in healthy aging, with the opportunity to translate clinical interventions into non-pharmacological tools for a growing, yet underserved population of older survivors. TRIAL REGISTRATION NCT03955627.
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Affiliation(s)
- Shirley M Bluethmann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America.
| | - Cristina Truica
- Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Nancy Olsen
- Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Christopher Sciamanna
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Department of Medicine, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Vernon M Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, United States of America; Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, United States of America; Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, PA, United States of America
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16
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Vashi R, Patel BM, Goyal RK. Keeping abreast about ashwagandha in breast cancer. JOURNAL OF ETHNOPHARMACOLOGY 2021; 269:113759. [PMID: 33359916 DOI: 10.1016/j.jep.2020.113759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 10/29/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ashwagandha has been used as an ayurvedic medicine in the form of 'Rasayana' (as a tonic) even before 3000 BCE in India. As per Ayurveda, it has long been used traditionally for the treatment of inflammation, weakness, impotence, pulmonary tuberculosis. This plant is also beneficial in lumbago and leucorrhea in the female. In the recent past, Withania has shown its anti-cancerous activity in various experimental models. In addition, Withania also possesses many other properties such as anti-oxidant, anti-stress, adaptogenic, and regenerative which will eventually be beneficial and safe in treating cancer patients. AIM OF THE STUDY This review aims to provide experimental evidence along with a deeper insight into molecular mechanisms of Ashwagandha (Withania somnifera (L.) Dunal) through which it acts as a chemotherapeutic agent against different types of breast cancer. MATERIALS AND METHODS Literature searches with the help of electronic online databases (Elsevier, Google Scholar, Scopus, Springer Link, ScienceDirect, ResearchGate, PubMed) were carried out. The timeline for collection of data for the review article was from 2000 to 2019. The plant name was validated from The Plant List (2013). Version 1.1. Published on http://www.theplantlist.org/(accessed 21st March 2020). RESULTS Various forms of Withania somnifera were used and several in vitro, in vivo, and clinical studies were reported by researchers. They found ashwagandha to exhibit anti-apoptotic, anti-metastatic, anti-invasive and anti-inflammatory properties and gave the evidence that ashwagandha has a capability for averting and treating breast cancer. CONCLUSION Various in vitro and in vivo studies suggested Ashwagandha may possess a potential for treating breast cancer, especially ER/PR positive breast cancer and triple-negative breast cancer. A clinical trial has also been conducted in the past that suggested its potential in refining quality of life in breast cancer patients. Studies directed towards molecular pathways have helped in unravelling the key mechanisms of ashwagandha. Future research should be directed towards translational studies involving breast cancer patients. These will reinforce the ancient power of our Ayurvedic medicine.
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Affiliation(s)
- Ruju Vashi
- Institute of Pharmacy, Nirma University, Ahmedabad, 382 481, India.
| | - Bhoomika M Patel
- Institute of Pharmacy, Nirma University, Ahmedabad, 382 481, India.
| | - Ramesh K Goyal
- Delhi Pharmaceutical Sciences Research University, Delhi, India.
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17
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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18
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Bell SG, Dalton L, McNeish BL, Fang F, Henry NL, Kidwell KM, McLean K. Aromatase inhibitor use, side effects and discontinuation rates in gynecologic oncology patients. Gynecol Oncol 2020; 159:509-514. [PMID: 32847676 PMCID: PMC8036903 DOI: 10.1016/j.ygyno.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/11/2020] [Indexed: 01/29/2023]
Abstract
Objective. Aromatase inhibitors (AI) are frequently prescribed in gynecologic oncology. We sought to define the frequency and duration of AI use, characterize AI side effects and determine the reasons for discontinuation in these patients. Methods. Uterine and ovarian cancer patients with AI use for gynecologic cancer therapy were identified retrospectively. Data were abstracted from the electronic medical record, including cancer type, stage, prior cancer treatments, body mass index, concurrent medications, prevalence of AI side effects before and during AI therapy, length of AI treatment and reason for AI discontinuation. Results. 146 women received AI therapy, with 68 for ovarian cancer (46.6%) and 78 for uterine cancer (53.4%). The majority (71.9%) had advanced stage disease at diagnosis. 54.1% noted AI-associated side effects within the first three visits after starting AI therapy. The most common side effects were arthralgias (29.5%), hot flashes (25.3%), new/worsening fatigue (16.4%), muscle or joint stiffness (8.2%) and myalgias (6.8%). The mean duration of therapy was 14.7 months. Gabapentin or selective serotonin reuptake inhibitor (SSRI) use was associated with decreased musculoskeletal side effects (gabapentin: p < .001, OR 0.88, 95% CI 0.83–0.94; SSRI: p < .001, OR 0.82, 95% CI 0.77–0.89). The most common reason for AI discontinuation was disease progression (87.9%), with 5.0% discontinuing due to side effects and 7.1% for other reasons. Conclusion. AI therapy for gynecologic cancers is frequently associated with musculoskeletal side effects, but rarely leads to treatment discontinuation. Thus, AI side effects should be assessed in gynecologic cancer patients to allow potential mitigation of symptoms through adjunct therapies.
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Affiliation(s)
- Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Liam Dalton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Brendan L McNeish
- Department of Physical Medicine and Rehabilitation, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Fang Fang
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - N Lynn Henry
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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Tenti S, Correale P, Cheleschi S, Fioravanti A, Pirtoli L. Aromatase Inhibitors-Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects. Int J Mol Sci 2020; 21:E5625. [PMID: 32781535 PMCID: PMC7460580 DOI: 10.3390/ijms21165625] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
Aromatase inhibitors (AIs) have radically changed the prognosis of hormone receptor positive breast cancer (BC) in post-menopausal women, and are a mainstay of the adjuvant therapy for BC after surgery in place of, or following, Tamoxifen. However, AIs aren't side effect-free; frequent adverse events involve the musculoskeletal system, in the form of bone loss, AI-associated arthralgia (AIA) syndrome and autoimmune rheumatic diseases. In this narrative review, we reported the main clinical features of these three detrimental conditions, their influence on therapy adherence, the possible underlying molecular mechanisms and the available pharmacological and non-pharmacological treatments. The best-known form is the AIs-induced osteoporosis, whose molecular pathway and therapeutic possibilities were extensively investigated in the last decade. AIA syndrome is a high prevalent joint pain disorder which often determines a premature discontinuation of the therapy. Several points still need to be clarified, as a universally accepted diagnostic definition, the pathogenetic mechanisms and satisfactory management strategies. The association of AIs therapy with autoimmune diseases is of the utmost interest. The related literature has been recently expanded, but many issues remain to be explored, the first being the molecular mechanisms.
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Affiliation(s)
- Sara Tenti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Pierpaolo Correale
- Medical Oncology Unit, Grand Metropolitan Hospital “Bianchi-Melacrino-Morelli”, 89121 Reggio Calabria, Italy;
| | - Sara Cheleschi
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Antonella Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Luigi Pirtoli
- Sbarro Institute for Cancer Research and Molecular Medicine-Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
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Sheng JY, Visvanathan K, Thorner E, Wolff AC. Breast cancer survivorship care beyond local and systemic therapy. Breast 2020; 48 Suppl 1:S103-S109. [PMID: 31839149 DOI: 10.1016/s0960-9776(19)31135-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite persistent inequities in access to care and treatments, advances in combined modality care have led to a steady improvement in outcomes for breast cancer patients across the globe. When estimating the magnitude of clinical benefit of therapies, providers and patients must contend with a multitude of factors that impact treatment decisions and can have long-term effects on quality of life and survival. These include commonly described early toxicities, like aromatase inhibitor-associated musculoskeletal syndrome and neuropathy. But longer-term comorbidities often observed among cancer survivors including weight gain, obesity, infertility, psychological distress, sexual dysfunction, second cancers, bone loss, and body image issues can have lasting effects on quality of life. Equally important, system-level factors such as access to care and resource allocation can have a systemic impact on survival and on the quality of survivorship. Financial toxicity including underemployment can have a lasting impact on patients and caregivers. The resulting disparities in access to treatment can help explain much of the observed variability in outcomes, even within high-income countries like the US. This article revisits some of secondary effects from therapies discussed in a prior 2015 review article, along with other impediments to the optimal delivery of breast cancer care that can affect patients anywhere.
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Affiliation(s)
- Jennifer Y Sheng
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Kala Visvanathan
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
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21
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Thiazole-containing compounds as therapeutic targets for cancer therapy. Eur J Med Chem 2019; 188:112016. [PMID: 31926469 DOI: 10.1016/j.ejmech.2019.112016] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/13/2022]
Abstract
In the last few decades, considerable progress has been made in anticancer agents development, and several new anticancer agents of natural and synthetic origin have been produced. Among heterocyclic compounds, thiazole, a 5-membered unique heterocyclic motif containing sulphur and nitrogen atoms, serves as an essential core scaffold in several medicinally important compounds. Thiazole nucleus is a fundamental part of some clinically applied anticancer drugs, such as dasatinib, dabrafenib, ixabepilone, patellamide A, and epothilone. Recently, thiazole-containing compounds have been successfully developed as possible inhibitors of several biological targets, including enzyme-linked receptor(s) located on the cell membrane, (i.e., polymerase inhibitors) and the cell cycle (i.e., microtubular inhibitors). Moreover, these compounds have been proven to exhibit high effectiveness, potent anticancer activity, and less toxicity. This review presents current research on thiazoles and elucidates their biological importance in anticancer drug discovery. The findings may aid researchers in the rational design of more potent and bio-target specific anticancer drug molecules.
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22
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Kim S, Han J, Lee MY, Jang MK. The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: Insights from focus group interviews. J Clin Nurs 2019; 29:758-769. [PMID: 31769562 DOI: 10.1111/jocn.15114] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/21/2019] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To identify the experience of breast cancer survivors regarding cancer-related fatigue, exercise and exercise adherence. BACKGROUND Cancer-related fatigue is a common symptom among cancer survivors that limits quality of life. Despite exercise being recommended as a viable solution to manage cancer-related fatigue, relatively few research studies on the experience of cancer-related fatigue and exercise adherence have been conducted. DESIGN This was a qualitative study to identify breast cancer survivors' experience of cancer-related fatigue, exercise and exercise adherence. This paper adhered to the COREQ checklist in reporting. METHODS Four focus group interviews were conducted with 16 breast cancer survivors who had fatigue score of 4 out of 10 (moderate fatigue) or greater. Ethical approval was obtained and participants met for focus group interview discussion. The interview guide included questions on cancer-related fatigue, barriers and facilitators of exercising, strategies for exercise adherence and suggestions for a supportive programme. RESULTS Four themes were identified through thematic analysis: (a) The insidious and overpowering nature of cancer-related fatigue; (b) exercising when experiencing fatigue surrounded by prevailing myths; (c) multiple barriers to exercise; and (d) facilitative factors to continue exercising despite fatigue. CONCLUSIONS Participants' experience of moderate or greater cancer-related fatigue prevented them from exercising, despite knowing its importance, and limited them to passive activities. Misconceptions that exercise is associated with lymphedema and risk of recurrence, poor psychosocial self-image and lack of clear knowledge and exercise programmes for cancer survivors further limited adherence to exercise. In contrast, finding comfort and strength through exercising and interacting with other breast cancer survivors were facilitative factors. RELEVANCE TO CLINICAL PRACTICE The insights shared by breast cancer survivors experiencing cancer-related fatigue can contribute to developing an exercise adherence programme as a way to manage and alleviate fatigue and establish healthy survivorship care.
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Affiliation(s)
- Sue Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Jeehee Han
- Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Min Young Lee
- Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Min Kyeong Jang
- University of Illinois Cancer Center, Chicago, IL, USA.,College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Sheng JY, Blackford AL, Bardia A, Venkat R, Rosson G, Giles J, Hayes DF, Jeter SC, Zhang Z, Hayden J, Nguyen A, Storniolo AM, Tarpinian K, Henry NL, Stearns V. Prospective evaluation of finger two-point discrimination and carpal tunnel syndrome among women with breast cancer receiving adjuvant aromatase inhibitor therapy. Breast Cancer Res Treat 2019; 176:617-624. [PMID: 31079282 DOI: 10.1007/s10549-019-05270-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Aromatase inhibitors (AIs) are associated with musculoskeletal symptoms and risk of developing carpal tunnel syndrome (CTS), which can impair quality of life and prompt treatment discontinuation. The incidence of CTS and clinical utility of diagnostic tests such as 2-point discrimination (2-PD) have not been prospectively examined among women receiving AIs. METHODS Postmenopausal women with stage 0-III hormone receptor-positive breast cancer who were enrolled in a randomized clinical trial investigating adjuvant AIs (Exemestane and Letrozole Pharmacogenetics, ELPh) underwent prospective evaluation of 2-PD with the Disc-criminator™ (sliding aesthesiometer) and completed a CTS questionnaire at baseline, 3, 6, and 12 months, following initiation of AI. Changes in mean 2-PD were analyzed with multivariable mixed effects modelling. A p value < 0.05 was considered statistically significant. RESULTS Of 100 women who underwent baseline 2-PD testing, CTS was identified by questionnaire in 11% at baseline prior to AI initiation. Prevalence of CTS at any time in the first year was 26%. A significant increase in worst 2-PD score was observed from baseline to 3 months (3.7 mm to 3.9 mm, respectively, p = 0.03) when adjusted for age, prior chemotherapy, randomized treatment assignment, and diabetes. There were no significant differences in treatment discontinuation due to CTS between the arms. CONCLUSION For women receiving adjuvant AI, 2-PD scores were significantly worse at 3 months compared to baseline. Studies are required to assess whether change in 2-PD is an adequate objective assessment for CTS with AI therapy. Early diagnosis of CTS may expedite management, improve AI adherence, and enhance breast cancer outcomes.
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Affiliation(s)
- Jennifer Y Sheng
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Amanda L Blackford
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Aditya Bardia
- Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Raghunandan Venkat
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gedge Rosson
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jon Giles
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Stacie C Jeter
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Zhe Zhang
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.,Pfizer, San Diego, CA, USA
| | - Jill Hayden
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Anne Nguyen
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | | | - Karineh Tarpinian
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.,The Emmes Corporation, Rockville, MD, USA
| | - Norah Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Vered Stearns
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA. .,Johns Hopkins School of Medicine, Breast Cancer Research Chair in Oncology, Sidney Kimmel Comprehensive Cancer Center, Under Armour Breast Health Innovation Center, Skip Viragh Building, 10-291, 201 North Broadway, Baltimore, MD, 21287, USA.
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Plasma levels of Semaphorin 4D are decreased by adjuvant tamoxifen but not aromatase inhibitor therapy in breast cancer patients. J Bone Oncol 2019; 16:100237. [PMID: 31011525 PMCID: PMC6461588 DOI: 10.1016/j.jbo.2019.100237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 01/28/2023] Open
Abstract
Background Semaphorin 4D (Sema4D) is a glycoprotein that inhibits bone formation and has been associated with cancer progression and the occurrence of bone metastases. Recently, Sema4D expression has been linked to estrogen signaling in breast cancer. Endocrine therapies like tamoxifen and aromatase inhibitors (AI) are a standard therapeutic approach in hormone receptor positive breast cancers. Tamoxifen exerts ER-agonistic effects on bone, whereas AI negatively affect bone health by increasing resorption and fracture risk. The effect of endocrine therapies on circulating Sema4D levels in breast cancer patients has not been investigated yet. Methods We measured circulating Sema4D plasma levels at primary diagnosis and in a follow-up sample 12 months after surgery in a cohort of 46 pre- and postmenopausal women with primary estrogen receptor positive breast cancer receiving adjuvant tamoxifen or AI. Results The mean baseline levels ± SD for Sema4D were 441.6 ± 143.4 pmol/l. No significant differences in total plasma Sema4D were observed when stratifying the patients according to age, menopausal status, tumor subtype, nodal and hormone receptor status, or tumor size. However, Sema4D levels were significantly reduced by 28% (p<0.001) in tamoxifen treated patients 12 months after surgery, whereas no alteration was observed in patients treated with AI. Conclusion This finding potentially represents an additional mechanism of the bone-protective properties of tamoxifen and further emphasizes a link between Sema4D and estrogen receptor signaling.
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25
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Marsden J, Marsh M, Rigg A. British Menopause Society consensus statement on the management of estrogen deficiency symptoms, arthralgia and menopause diagnosis in women treated for early breast cancer. Post Reprod Health 2019; 25:21-32. [PMID: 30776968 DOI: 10.1177/2053369118824920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This guidance document by the British Menopause Society provides an overview of the management of women experiencing estrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended that breast cancer patients are referred to health care professionals with an expertise in menopause for the management of such symptoms, which in turn often involves liaison with patients' breast cancer teams. However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points.
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Affiliation(s)
| | | | - Anne Rigg
- 2 Guy's and St Thomas' Hospital, London, UK
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26
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Alhanafy AM, Labeeb A, Khalil A. The Role of Diuretics in Treatment of Aromatase Inhibitors Induced Musculoskeletal Symptoms in Women with Non Metastatic Breast Cancer. Asian Pac J Cancer Prev 2018; 19:3525-3531. [PMID: 30583679 PMCID: PMC6428535 DOI: 10.31557/apjcp.2018.19.12.3525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Around 50% of women receiving Aromatase Inhibitors (AIs) develop musculoskeletal symptoms which may become severe causing interruption of treatment. Patients with AI-induced arthralgia had higher rates of joint effusions and fluid in the tendons, so use of diuretics may be helpful. Methods: This prospective phase II study was conducted in department of clinical oncology and nuclear medicine, Menoufia University Hospital, Egypt, between Jan. to Dec. 2015. Fifty Women with stage I,II and III breast cancer receiving AIs as adjuvant hormonal treatment complaining of AIs related musculoskeletal symptoms received Lasilactone® 50 mg tablet; (an oral combination of Frusemide 20mg/Spironolactone 50 mg), every other day for 4 weeks. Patients were assessed by modified Western Ontario and McMaster Universities osteoarthritis (WOMAC) index for lower limb and the quick Disabilities of the Arm, Shoulder and Hand Score (DASH) scoring system for upper limbs, Arabic versions, at baseline and after 4 weeks of treatment. Results: The mean WOMAC pain score improved significantly (6.0 v 10; P < 0.001), the mean WOMAC stiffness score improved (2.3 v 3.9; P = 0.002), the mean WOMAC functional score improved (8.7 v 15; P < 0.001), the total WOMAC score improved (17 v 29; P < 0.001), also a significant difference was noticed for the quick DASH score; total score (16 v 25; P = 0.02) After use of diuretics for 4 weeks of treatment compared with baseline scores. Conclusions: The use of diuretics effectively reduces AI related musculoskeletal symptoms with good tolerance.
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Affiliation(s)
- Alshimaa Mahmoud Alhanafy
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El kom, Egypt.
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27
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Choo SB, Saifulbahri A, Zullkifli SN, Fadzil ML, Redzuan AM, Abdullah N, Bustamam RSA, Ahmad HZ, Shah NM. Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia. Climacteric 2018; 22:175-181. [PMID: 30556740 DOI: 10.1080/13697137.2018.1540563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study was conducted to determine the prevalence and severity of menopausal symptoms and their associated risk factors among postmenopausal breast cancer patients receiving adjuvant endocrine therapy. METHODS Postmenopausal breast cancer patients on endocrine therapy were recruited at three hospitals in Malaysia. Presence and severity of menopausal symptoms were determined using the Menopause Rating Scale. Sociodemographic and clinical data were collected from medical records. RESULTS A total of 192 patients participated in this study. Commonly reported symptoms were musculoskeletal pain (59.9%), physical and mental exhaustion (59.4%), and hot flushes (41.1%). Multivariate analyses indicated that increasing number of years after menopause until the start of endocrine therapy was significantly associated with less likelihood of reporting menopausal symptoms and musculoskeletal pain. Patients with primary or secondary education levels reported significantly less menopausal urogenital symptoms compared to patients with a tertiary education level. Patients using aromatase inhibitors were twice as likely to experience musculoskeletal pain compared to patients using tamoxifen (odds ratio, 2.18; 95% confidence interval, 1.06-4.50; p < 0.05). CONCLUSION Menopausal symptoms and musculoskeletal pain are common problems encountered by postmenopausal breast cancer patients receiving adjuvant endocrine therapy and should be closely monitored for successful treatment.
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Affiliation(s)
- S B Choo
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - A Saifulbahri
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - S N Zullkifli
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - M L Fadzil
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - A Md Redzuan
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
| | - N Abdullah
- b Department of Surgery , Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur , Malaysia
| | - R S Ahmad Bustamam
- c Department of Radiotherapy and Oncology , Hospital Kuala Lumpur , Kuala Lumpur , Malaysia
| | - H Z Ahmad
- d Department of Radiotherapy and Oncology , National Cancer Institute , Putrajaya , Malaysia
| | - N Mohamed Shah
- a Faculty of Pharmacy , Universiti Kebangsaan Malaysia , Kuala Lumpur , Malaysia
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Mohamed AAR, Ahmed MM, Gomaa M, Ebraheim LLM. Bone health consequence of adjuvant Anastrozole in monotherapy or associated with biochanin-A in ovariectomized rat model. Life Sci 2018; 212:159-167. [PMID: 30290186 DOI: 10.1016/j.lfs.2018.09.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/01/2018] [Accepted: 09/28/2018] [Indexed: 02/07/2023]
Abstract
AIMS We investigate the consequence of adjuvant anastrozole (ANA) in monotherapy or associated with biochanin A (BCA) in ovariectomized (OVX) rat model and the degree of developing bone loss in both conditions. MATERIALS AND METHODS Sixty female rats were assigned to six groups. Five groups were bilaterally OVX, and one was sham operated. The five groups were; ANA group (0.5 mg/kg b.wt orally), BCA (5 mg/kg b.wt intraperitoneally (I/P), co-treated group (BCA + ANA), two control groups receiving even distilled water orally or DMSO I/P for twenty weeks. Bone turnover biomarkers BALP, OC, PTH, TRAP and TNFα were determined in serum. Bone mineral content, histological and morphometric measurements on rat femurs were performed. BMD by X-ray technique on tibias of rats and CT analysis of lumbar vertebrae of all treated and sham groups were applied. KEY FINDINGS There was marked elevation in bone turnover biomarkers with high serum Ca and P content in the ANA-treated rats. Moreover marked elevation of TNFα, PTH, TC and TG, ANA caused severe changes in the BMD detected by X-ray in tibial bones and CT analysis of lumbar vertebrae of OVX rats. While I/P injection of BCA ameliorated the adverse bone health decrements caused by ANA. SIGNIFICANCE The study highlights the importance of the BCA supplementation in accordance with the ANA therapy in case of ovariectomized rat model of osteoporosis which is clinically presented in Postmenopausal women with breast cancer during which considerable risk of developing osteoporosis is predicted during treatment.
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Affiliation(s)
| | - Mona M Ahmed
- Dept. of Forensic Medicine and Toxicology, Zagazig University, Zagazig, Egypt
| | - Mohamed Gomaa
- Dept. of Surgery, Zagazig University, Zagazig, Egypt
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29
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External Beam Irradiation Preferentially Inhibits the Endochondral Pathway of Fracture Healing: A Rat Model. Clin Orthop Relat Res 2018; 476:2076-2090. [PMID: 30024459 PMCID: PMC6259865 DOI: 10.1097/corr.0000000000000395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND External beam irradiation is an accepted treatment for skeletal malignancies. Radiation acts on both cancerous and normal cells and, depending on the balance of these effects, may promote or impair bone healing after pathologic fracture. Previous studies suggest an adverse effect of radiation on endochondral ossification, but the existence of differential effects of radiation on the two distinct bone healing pathways is unknown. QUESTIONS/PURPOSES The purpose of this study was to investigate the differential effects of external beam irradiation on endochondral compared with intramembranous ossification with intramedullary nail and plate fixation of fractures inducing the two respective osseous healing pathways through assessment of (1) bone biology by histomorphometric analysis of cartilage area and micro-CT volumetric assessment of the calcified callus; and (2) mechanical properties of the healing fracture by four-point bending failure analysis of bending stiffness and strength. METHODS Thirty-six male Sprague-Dawley rats underwent bilateral iatrogenic femur fracture: one side was repaired with an intramedullary nail and the other with compression plating. Three days postoperatively, half (n = 18) received 8-Gray external beam irradiation to each fracture. Rodents were euthanized at 1, 2, and 4 weeks postoperatively (n = 3/group) for quantitative histomorphometry of cartilage area and micro-CT assessment of callus volume. The remaining rodents were euthanized at 3 months (n = 9/group) and subjected to four-point bending tests to assess stiffness and maximum strength. RESULTS Nailed femurs that were irradiated exhibited a reduction in cartilage area at both 2 weeks (1.08 ± 1.13 mm versus 37.32 ± 19.88 mm; 95% confidence interval [CI] of the difference, 4.32-68.16 mm; p = 0.034) and 4 weeks (4.60 ± 3.97 mm versus 39.10 ± 16.28 mm; 95% CI of the difference, 7.64-61.36 mm; p = 0.023) compared with nonirradiated fractures. There was also a decrease in the volume ratio of calcified callus at 4 weeks (0.35 ± 0.08 versus 0.51 ± 0.05; 95% CI of the difference, 0.01-0.31; p = 0.042) compared with nonirradiated fractures. By contrast, there was no difference in cartilage area or calcified callus between irradiated and nonirradiated plated femurs. The stiffness (128.84 ± 76.60 N/mm versus 26.99 ± 26.07 N/mm; 95% CI of the difference, 44.67-159.03 N/mm; p = 0.012) and maximum strength (41.44 ± 22.06 N versus 23.75 ± 11.00 N; 95% CI of the difference, 0.27-35.11 N; p = 0.047) of irradiated plated femurs was greater than the irradiated nailed femurs. However, for nonirradiated femurs, the maximum strength of nailed fractures (36.05 ± 17.34 N versus 15.63 ± 5.19 N; 95% CI of the difference, 3.96-36.88 N; p = 0.022) was greater than plated fractures, and there was no difference in stiffness between the nailed and plated fractures. CONCLUSIONS In this model, external beam irradiation was found to preferentially inhibit endochondral over intramembranous ossification with the greatest impairment in healing of radiated fractures repaired with intramedullary nails compared with those fixed with plates. Future work with larger sample sizes might focus on further elucidating the observed differences in mechanical properties. CLINICAL RELEVANCE This work suggests that there may be a rationale for compression plating rather than intramedullary nailing of long bone fractures in select circumstances where bony union is desirable, adjunctive radiation treatment is required, and bone stock is sufficient for plate and screw fixation.
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30
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Mitsimponas N, Klouva E, Tryfonopoulos D, Grivas A, Demiri S, Koumakis G, Gouveris P. Aromatase Inhibitor-Associated Tendinopathy and Muscle Tendon Rupture: Report of Three Cases of This Exceedingly Rare Adverse Event. Case Rep Oncol 2018; 11:557-561. [PMID: 30186139 PMCID: PMC6120376 DOI: 10.1159/000491874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
Aromatase inhibitors (AIs) are a commonly used antihormonal therapy in the treatment of breast cancer in postmenopausal women, specifically in the treatment of hormone receptor-positive breast cancer. AI-associated tendinopathy and muscle tendon rupture is exceedingly rare. Until now, only one case with AI-associated severe tendinopathy has been reported in the medical literature, and there are no recorded cases of AI-associated muscle tendon rapture. We report three cases of postmenopausal women with hormone receptor-positive breast cancer, who experienced tendinopathy or muscle tendon rupture under antihormonal treatment with letrozole. All of the three women were in the adjuvant setting, and the treatment of tendinopathy or tendon rupture consisted of AI discontinuation, initiation of corticosteroids, or surgical treatment. Diagnosis was made via MRI. Furthermore, in our cases, there were no signs of underlying systemic disease, there was no abnormal physical activity preceding the complaints, and there was no use of other drugs beside letrozole. AIs are one of the most commonly used drugs in antihormonal therapy for hormone receptor-positive breast cancer. In every case of a female patient with hormone receptor-positive breast cancer under treatment with AIs and arthralgia, an MRI should be performed in order to exclude the presence of tendinopathy or muscle tendon rupture.
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Affiliation(s)
| | - Evangelia Klouva
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
| | | | | | - Stamatina Demiri
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
| | - George Koumakis
- Second Oncological Clinic, Agios Savvas Hospital, Athens, Greece
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Zhang X, Peng N, Yu MW, Zhang GL, Sun X, Yang GW, Li C, Yang L, Wang XM. Chinese Medicine Yishen Jiangu Granules () on Aromatase Inhibitor-Associated Musculoskeletal Symptoms. Chin J Integr Med 2018; 24:867-872. [PMID: 30062634 DOI: 10.1007/s11655-017-2928-4] [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: 05/04/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the effectiveness of Yishen Jiangu Granules (, YSJGG) on aromatase inhibitor-associated musculoskeletal symptoms (AIMSS). METHODS A single-arm, open-label study was conducted in 34 postmenopausal women with breast cancer who experienced AIMSS. Patients were treated with YSJGG for 12 weeks (12.4 g orally twice daily). The primary outcome was a change in the mean worst pain score of Brief Pain Inventory-Short Form (BPI-SF) over 12 weeks, and the second outcomes included changes in pain severity and pain-related interference of BPI-SF and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH), the Functional Assessment of Cancer Therapy-Breast (FACT-B), bone mineral density (BMD) and blood indices such as calcium (Ca), phosphate (P), and alkaline phosphatase (ALP). RESULTS Of 37 women recruited, 30 initiated the therapy and 24 were evaluable at 12 weeks. The primary outcome (BPI-SF worst pain scores) achieved a 2.17-point reduction compared with baseline (5.75±1.87 vs 3.58±2.15, P<0.01). There were reductions in pain severity (decreased 1.65, P<0.01) and pain-related interference (decreased 2.55, P<0.01). The changes in WOMAC and M-SACRAH scores were similar to BPI-SF (P<0.05). In the FACT-B, only physical well-being and functional well-being were improved compared with baseline (P<0.05). No clinical differences were found in BMD, Ca, P and ALP. CONCLUSION YSJGG is an effective and well-tolerated agent to reduce AIMSS.
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Affiliation(s)
- Xing Zhang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, 100101, China
| | - Nan Peng
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Ming-Wei Yu
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Gan-Lin Zhang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Xu Sun
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Guo-Wang Yang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Chen Li
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Lin Yang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China
| | - Xiao-Min Wang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, 100101, China.
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Santa-Maria CA, Bardia A, Blackford AL, Snyder C, Connolly RM, Fetting JH, Hayes DF, Jeter SC, Miller RS, Nguyen A, Quinlan K, Rosner GL, Slater S, Storniolo AM, Wolff AC, Zorzi J, Henry NL, Stearns V. A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: the ZAP trial. Breast Cancer Res Treat 2018; 171:121-129. [PMID: 29752687 DOI: 10.1007/s10549-018-4811-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) are common adverse events of AIs often leading to drug discontinuation. We initiated a prospective clinical trial to evaluate whether bisphosphonates are associated with reduced incidence of AIMSS. METHODS In the single-arm trial, the Zoledronic Acid Prophylaxis (ZAP) trial, we compared the incidence of AIMSS against historical controls from the Exemestane and Letrozole Pharmacogenomics (ELPh) trial. Eligible women were postmenopausal with stage 0-III breast cancer planning to receive adjuvant AIs. AIMSS was assessed using the Health Assessment Questionnaire and Visual Analog Scale over 12 months in both trials. Participants in the ZAP trial received zoledronic acid prior to initiating letrozole and after 6 months; ELPh participants included in the analysis were taking letrozole but not bisphosphonates. We analyzed patient-reported outcomes (PROs) and bone density in the ZAP trial using mixed-effects linear regression models and paired t tests, respectively. RESULTS From 2011 to 2013, 59 postmenopausal women enrolled in ZAP trial. All 59 (100%) women received baseline and 52 (88%) received 6-month zoledronic acid, and had similar characteristics to historical controls from the ELPh trial (n = 206). Cumulatively during the first year of AI, 37 and 67% of ZAP and ELPh participants reported AIMSS (p < 0.001), respectively. Within the ZAP trial, we did not observe significant changes in other PROs; however, we report improvements in bone mineral density. CONCLUSIONS Compared to historical controls, zoledronic acid administered concomitantly with adjuvant AIs was associated with a reduced incidence of AIMSS. A randomized controlled trial is required to confirm these findings.
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Affiliation(s)
- Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aditya Bardia
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John H Fetting
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - Stacie C Jeter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Anne Nguyen
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, USA
| | - Katie Quinlan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shannon Slater
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jane Zorzi
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nora Lynn Henry
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- University of Utah, Salt Lake City, USA
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Yoo TK, Jang MJ, Lee E, Moon HG, Noh DY, Han W. Endocrine Treatment-Related Symptoms and Patient Outcomes in Breast Cancer: A Meta-Analysis. J Breast Cancer 2018; 21:37-44. [PMID: 29628982 PMCID: PMC5880964 DOI: 10.4048/jbc.2018.21.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose An association between endocrine treatment-related symptoms and breast cancer recurrence has been suggested previously; however, conflicting results have been reported. We performed a meta-analysis of published studies to clarify this relationship. Methods We systematically searched PubMed, Embase, Scopus, and the Cochrane database for studies investigating the association between endocrine treatment-related symptoms and patient survival. Random-effects meta-analysis was conducted with recurrence rate as the primary outcome. Results Out of 7,713 retrieved articles, six studies were included. In patients who received endocrine treatment, the presence of any endocrine treatment-related symptom was found to be associated with a lower recurrence rate in comparison to an absence of any symptoms (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.66-0.87). This relationship persisted in patients presenting with only vasomotor or only musculoskeletal symptoms (HR, 0.74, 95% CI, 0.63-0.87; HR, 0.69, 95% CI, 0.55-0.86, respectively). At both time-points of symptom evaluation (3 months and 12 months), patients with endocrine treatment-related symptoms had a lower recurrence rate (HR, 0.74, 95% CI, 0.66-0.84; HR, 0.79, 95% CI, 0.69-0.90, respectively). This association was also significant in pooled studies including patients with and without baseline symptoms (HR, 0.73, 95% CI, 0.54-0.99; HR, 0.76, 95% CI, 0.69-0.85, respectively). Conclusion Endocrine treatment-related symptoms are significantly predictive of lower recurrence rate in breast cancer patients, regardless of the type of symptoms, time-point of evaluation, or inclusion of baseline symptoms. These symptoms could be biomarkers for the prediction of long-term responses to endocrine treatment in patients with breast cancer.
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Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Eunshin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Nahm N, Mee S, Marx G. Efficacy of management strategies for aromatase inhibitor-induced arthralgia in breast cancer patients: a systematic review. Asia Pac J Clin Oncol 2018; 14:374-382. [PMID: 29380528 DOI: 10.1111/ajco.12845] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/12/2017] [Indexed: 01/22/2023]
Abstract
Aromatase inhibitors are the gold standard in the treatment of hormone receptor-positive breast cancer, but lead to an arthralgia syndrome which is implicated in 13-22% of noncompliance. This is the first systematic review of the efficacy of existing management strategies for this side effect. Eligible studies were retrieved from computer searches of Medline, Cochrane and Embase and the significant intervention groups were identified. The risk of bias of selected studies was evaluated and the relevant data items were extracted, summarized and analyzed. A total of 21 studies were discussed in this review representing 12 different interventions. While several trials had positive findings, the major methodological limitations of the studies meant that no definitive evidence could be found supporting any of the interventions. Future trials are needed which address the methodological problems identified in this review. Exercise holds promise for future research based on its proven benefit in breast cancer.
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Affiliation(s)
- Nicole Nahm
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
| | - Susie Mee
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
| | - Gavin Marx
- University of Sydney, Sydney Adventist Hospital, SAN Integrated Cancer Centre, Wahroonga, New South Wales, Australia
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Zaidi S, Hussain S, Verma S, Veqar Z, Khan A, Nazir SU, Singh N, Moiz JA, Tanwar P, Srivastava A, Rath GK, Mehrotra R. Efficacy of Complementary Therapies in the Quality of Life of Breast Cancer Survivors. Front Oncol 2018; 7:326. [PMID: 29376027 PMCID: PMC5768617 DOI: 10.3389/fonc.2017.00326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most common cancer diagnosed in women and the second most common cancer overall, ranking as the fifth cause of death from cancer. The chronicity of the disease produces long-term physiological and psychological manifestations, which adversely affect the quality of life of the individual. The primary treatment while managing cancer presents with various debilitating side effects. With the recent advances in treatment techniques that have improved the survival rate, patients suffer from continuing posttreatment complications. Patients seem to cope well with the stress of treatment of BC and sustain a normal life; however, the deterioration in physical well-being makes the patient functionally inefficient. Exercise has been proven to be an effective, safe, and feasible tool in combating the adverse effects of treatment, prevents complications and decreases the risk of BC-specific mortality. This review briefly presents an overview of the burden of the disease and its management strategies. Owing to the heterogeneity of the population and the multitude of therapies they receive, the response of each patient to treatment is different and so is the magnitude of adverse effects. The review discusses the late sequelae following treatment and evidence supporting the role of physical activity in their management. In conclusion, there is a need for personalized physical activity plans to be developed to suit the individual and their circumstances.
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Affiliation(s)
- Sahar Zaidi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Showket Hussain
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Shalini Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Asiya Khan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sheeraz Un Nazir
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
| | - Neha Singh
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenberg University, Gothenberg, Sweden
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
| | - Pranay Tanwar
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - G K Rath
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, Indian Council of Medical Research (NICPR-ICMR), New Delhi, India
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Laroche F, Perrot S, Medkour T, Cottu PH, Pierga JY, Lotz JP, Beerblock K, Tournigand C, Chauvenet L, Bouhassira D, Coste J. Quality of life and impact of pain in women treated with aromatase inhibitors for breast cancer. A multicenter cohort study. PLoS One 2017; 12:e0187165. [PMID: 29117210 PMCID: PMC5678681 DOI: 10.1371/journal.pone.0187165] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/14/2017] [Indexed: 12/02/2022] Open
Abstract
Women with hormone-dependent breast cancer are treated with aromatase inhibitors (AI) to slow disease progression by decreasing estrogen levels. However, AI have adverse effects, including pain, with potentially serious impact on quality of life (QOL) and treatment compliance. We evaluated quality of life during the first year of AI treatment, focusing particularly on the impact of pain. In a multicenter cohort study of 135 women with early-stage breast cancer, free of pain at the initiation of AI treatment, quality of life (by the EORTC QLQ-BR23), somatic and psychic symptoms, psychological characters, temperament and coping strategies were assessed at baseline and at each follow-up visit (1, 3, 6 and 12 months). The impact of treatment-induced pain on quality of life during follow-up was determined with repeated-measures regression models. These models were constructed to assess the effects of pain and pain type on quality of life during follow-up, taking into account predictors associated with quality of life at baseline. Prior ganglion resection, taxane treatment and chemotherapy, a high amplification score on the pain catastrophizing scale, and a high harm avoidance score on the personality questionnaire were associated with a significantly lower baseline QOL. Fifty-seven percent of women developed pain of five different types: upper or lower limb joint pain, diffuse pain, neuropathic pain, tendon pain and mixed pain. A significant decrease in QOL was noted in the women with pain, particularly for body image, sexual functioning and future perspectives. Moreover, the impact of pain on QOL depended on the type of pain experienced. In conclusion, women treated with aromatase inhibitors display changes in quality of life and the degree of change in quality of life depends mostly on the type of pain experienced. Oncologists and patients should be aware of painful adverse effects of AI and encouraged to provide or receive earlier and more appropriate management of these effects.
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Affiliation(s)
- Françoise Laroche
- Pain Clinic, Saint Antoine Hospital, Paris, France
- INSERM U 987 and U 938, Paris, France
| | - Serge Perrot
- INSERM U 987 and U 938, Paris, France
- Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris, France
| | - Terkia Medkour
- Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris, France
| | | | | | | | | | | | | | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Hôtel Dieu Hospital, Paris, France
- * E-mail:
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Mougalian SS, Epstein LN, Jhaveri AP, Han G, Abu-Khalaf M, Hofstatter EW, DiGiovanna MP, Silber AL, Adelson K, Pusztai L, Gross CP. Bidirectional Text Messaging to Monitor Endocrine Therapy Adherence and Patient-Reported Outcomes in Breast Cancer. JCO Clin Cancer Inform 2017; 1:1-10. [DOI: 10.1200/cci.17.00015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Up to 40% of patients with breast cancer may not adhere to adjuvant endocrine therapy. Therapy-related adverse effects (AEs) are important contributors to nonadherence. We developed a bidirectional text-message application, BETA-Text, that simultaneously tracks adherence, records symptoms, and alerts the clinical team. Patients and Methods We piloted our intervention in 100 patients. The intervention consisted of text messages to which patients responded for 3 months: daily, evaluating adherence; weekly, evaluating medication-related AEs; and monthly, regarding barriers to adherence. Concerning responses prompted a telephone call from a clinic nurse. The primary objective was to assess patient acceptance of this intervention using self-reported surveys. To compare participants with the general population at our institution, we assessed 100 consecutively treated patients as historical controls using medical record review. Results We approached 141 consecutive patients, 100 (71%) of whom agreed to participate and 89 of whom completed the intervention. A majority of patients reported that the intervention was easy to use (98%) and helpful in taking their medication (96%). Four patients discontinued therapy before 3 months, and 93% of patients who continued therapy took ≥ 80% of their medication. The frequency of AEs reported by participants via text was higher than that reported in clinical trials: hot flashes (72%), arthralgias (53%), and vaginal symptoms (35%). Approximately 39% of patients reported one or more severe AE that prompted an alert to the provider team to call the patient. Conclusion A daily bidirectional text-messaging system can monitor adherence and identify AEs and other barriers to adherence in real time without inconveniencing patients. AEs of endocrine therapy, as detected using this texting approach, are more prevalent than reported in clinical trials.
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Affiliation(s)
- Sarah S. Mougalian
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lianne N. Epstein
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ami P. Jhaveri
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Gang Han
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Maysa Abu-Khalaf
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Erin W. Hofstatter
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Michael P. DiGiovanna
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Andrea L.M. Silber
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kerin Adelson
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lajos Pusztai
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Cary P. Gross
- Sarah S. Mougalian, Lianne N. Epstein, Erin W. Hofstatter, Michael P. DiGiovanna, Andrea L.M. Silber, Kerin Adelson, Lajos Pusztai, and Cary P. Gross, Yale Cancer Center, Yale University; Sarah S. Mougalian, Kerin Adelson, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, CT; Ami P. Jhaveri, Lancaster General Health, Penn Medicine, Lancaster; Maysa Abu-Khalaf, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Tan X, Camacho TF, LeBaron VT, Blackhall LJ, Balkrishnan R. Opioid use among female breast cancer patients using different adjuvant endocrine therapy regimens. Breast Cancer Res Treat 2017. [PMID: 28639031 DOI: 10.1007/s10549-017-4348-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore differences in opioid use across different adjuvant endocrine therapy (AET) regimens, factors associated with opioid use, and the impact of opioid use on overall survival in female breast cancer patients treated with AET. METHODS This retrospective study analyzed 2006-2012 SEER-Medicare datasets, following patients for at least two years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone-receptor-positive, stage I-III breast cancer. They were also first-time AET users, and fee-for-service Medicare enrollees continuously enrolled in Medicare Parts A, B, and D. The main independent variable was the AET regimen. We measured whether patients used opioids after the initiation of AET. RESULTS After the adjustment of inverse probability treatment weights and unbalanced covariates, the average treatment effect probabilities of opioid use were similar between those who used aromatase inhibitors (AI) only and those used tamoxifen (TAM) only (56.2 vs. 55.3%, respectively). Opioid use probabilities for those who switched from AI to TAM were higher than those for the TAM-only and AI-only groups. Opioid use was also significantly associated with AET non-adherence. Opioid users had a significantly higher risk of death (adjusted hazard ratio [HR] = 1.59, p < 0.001). CONCLUSIONS Switching from AI to TAM was associated with a high likelihood of opioid use. Opioid use was significantly associated with AET non-adherence and higher risk of mortality in female Medicare beneficiaries with breast cancer even after adjusting for adherence.
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Affiliation(s)
- Xi Tan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Tareq Fabian Camacho
- Department of Public Health Sciences, School of Medicine, University of Virginia, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA
| | - Virginia T LeBaron
- Department of Acute & Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Leslie J Blackhall
- Department of Internal Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Rajesh Balkrishnan
- Department of Public Health Sciences, School of Medicine, University of Virginia, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA.
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Adjuvant tamoxifen but not aromatase inhibitor therapy decreases serum levels of the Wnt inhibitor dickkopf-1 while not affecting sclerostin in breast cancer patients. Breast Cancer Res Treat 2017; 164:737-743. [PMID: 28526959 DOI: 10.1007/s10549-017-4296-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/13/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Endocrine therapies, including tamoxifen or aromatase inhibitors, are indispensable for the treatment of patients with estrogen receptor (ER)- and/or progesterone-positive breast cancer. Whereas tamoxifen displays partial ER agonistic effects in bone, aromatase inhibitors increase bone resorption and fracture risk. The Wnt inhibitors dickkopf-1 (DKK-1) and sclerostin negatively impact bone formation and are considered targets for the treatment of bone disorders. However, the effect of endocrine therapies on serum DKK-1 and sclerostin levels in patients with primary breast cancer remains elusive. METHODS Serum DKK-1 and sclerostin levels were measured at primary diagnosis as well as 3-5 days and 12 months after surgery in a cohort of 45 pre- and postmenopausal women with primary estrogen receptor-positive breast cancer treated with adjuvant tamoxifen or aromatase inhibitors. RESULTS Mean baseline levels ±SD for DKK-1 and sclerostin were 29.7 ± 14.6 and 27.1 ± 16.2 pmol/l, respectively. A significant negative correlation of DKK-1 levels and age was observed (r = -0.32; p < 0.05), but not for sclerostin. Of note, DKK-1 levels were significantly lower in peri- and postmenopausal women compared to premenopausal patients (-47%; p < 0.05). In tamoxifen-treated patients, DKK-1 levels were reduced by 35% (p < 0.01) one year after surgery but remained unaltered in patients treated with aromatase inhibitors. No significant changes were observed for sclerostin. CONCLUSION DKK-1 serum levels were reduced in breast cancer patients receiving an adjuvant therapy with tamoxifen, possibly contributing to its bone-protective properties.
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Gender-specific differential expression of exosomal miRNA in synovial fluid of patients with osteoarthritis. Sci Rep 2017; 7:2029. [PMID: 28515465 PMCID: PMC5435729 DOI: 10.1038/s41598-017-01905-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/03/2017] [Indexed: 12/19/2022] Open
Abstract
The pathogenesis of osteoarthritis (OA) is poorly understood, and therapeutic approaches are limited to preventing progression of the disease. Recent studies have shown that exosomes play a vital role in cell-to-cell communication, and pathogenesis of many age-related diseases. Molecular profiling of synovial fluid derived exosomal miRNAs may increase our understanding of OA progression and may lead to the discovery of novel biomarkers and therapeutic targets. In this article we report the first characterization of exosomes miRNAs from human synovial fluid. The synovial fluid exosomes share similar characteristics (size, surface marker, miRNA content) with previously described exosomes in other body fluids. MiRNA microarray analysis showed OA specific exosomal miRNA of male and female OA. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis identified gender-specific target genes/signaling pathways. These pathway analyses showed that female OA specific miRNAs are estrogen responsive and target TLR (toll-like receptor) signaling pathways. Furthermore, articular chondrocytes treated with OA derived extracellular vesicles had decreased expression of anabolic genes and elevated expression of catabolic and inflammatory genes. In conclusion, synovial fluid exosomal miRNA content is altered in patients with OA and these changes are gender specific.
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Calip GS, Xing S, Jun DH, Lee WJ, Hoskins KF, Ko NY. Polypharmacy and Adherence to Adjuvant Endocrine Therapy for Breast Cancer. J Oncol Pract 2017; 13:e451-e462. [PMID: 28287854 DOI: 10.1200/jop.2016.018317] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Many patients with breast cancer are treated for other conditions and experience polypharmacy with multiple concurrent medications. Our aim was to evaluate polypharmacy in relation to adherence to adjuvant endocrine therapy (AET) in breast cancer. METHODS We conducted a retrospective cohort study of women with incident, invasive breast cancer initiating AET (tamoxifen, letrozole, anastrozole, exemestane) between 2009 and 2013 in the Truven Health MarketScan Database. Polypharmacy and pill burden were measured for commonly used concurrent medications, including lipid-lowering drugs, antihypertensives, oral diabetes medications, insulin analogs, antidepressants, anxiolytics/antipsychotics, and opioid-containing analgesics. Polypharmacy was defined as frequent use (three or more dispensings) of a given medication class and by pill burden (total dispensings). Medication possession ratios (MPR) were estimated for subsequent 12-month intervals. Multivariable generalized estimating equation models were used to calculate odds ratios (ORs) and robust 95% CIs for associations with AET adherence (MPR ≥ 0.80). RESULTS Among 40,009 women, 74% were adherent in year +1 and continued to have high mean adherence (MPR = 0.79) among those continuing AET through year +3. Increasing polypharmacy ( P < .001) and pill burden ( P < .001) were associated with greater adherence, but effects differed by medication class. Frequent use of lipid-lowering drugs (OR, 1.42; 95% CI, 1.36 to 1.49) and antihypertensives (OR, 1.15; 95% CI, 1.10 to 1.20) were associated with higher odds of adherence; frequent use of opioid-containing analgesics (OR, 0.80; 95% CI, 0.77 to 0.83), anxiolytics/antipsychotics (OR, 0.95; 95% CI, 0.91 to 0.99), antidepressants (OR, 0.85; 95% CI, 0.82 to 0.89), and insulin therapy (OR, 0.82; 95% CI, 0.72 to 0.95) were associated with lower odds of adherence. CONCLUSION Associations between polypharmacy and adherence in breast cancer may be better characterized by understanding specific classes of medications used concurrently. Comprehensive medication therapy management, including ongoing pain evaluation and psychoactive therapies, is warranted.
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Affiliation(s)
- Gregory S Calip
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
| | - Shan Xing
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
| | - Da-Hae Jun
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
| | - Wan-Ju Lee
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
| | - Kent F Hoskins
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
| | - Naomi Y Ko
- University of Illinois at Chicago, Chicago, IL; Fred Hutchinson Cancer Research Center, Seattle, WA; and Boston University School of Medicine, Boston, MA
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Beckwée D, Leysen L, Meuwis K, Adriaenssens N. Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: a systematic review and meta-analysis. Support Care Cancer 2017; 25:1673-1686. [PMID: 28204994 DOI: 10.1007/s00520-017-3613-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/06/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although aromatase inhibitors have proven to be an effective treatment of hormone receptor-positive breast cancer in postmenopausal women, aromatase inhibitor-induced arthralgia (AIA) is an adverse event associated with low compliance with treatment. The aim of this literature study is to assess the prevalence of AIA and to provide an overview of significant predictors for the development of AIA. METHODS A systematic review was conducted using PubMed, Cochrane Library and Web of Science. A meta-analysis was performed and heterogeneity has been investigated by moderator analyses. The meta-analysis was repeated with studies that were considered as best evidence, i.e. studies with an above-average score on the STROBE checklist. RESULTS Twenty-one studies (13,177 participants) were included. Prevalence rates ranged from 0.200 to 0.737. Meta-analysis resulted in a pooled estimate of 0.459 (95% CI = [0.397-0.520) with a high heterogeneity (I 2 = 98%). Moderator analysis showed no differences regarding heterogeneity. Predictors for the development of AIA included a body mass index of 25-30 kg/m2 (OR = 0.33), taxane-based chemotherapy (OR = 4.08), stage III cancer (OR = 0.32) and a duration of menopause of 5-10 years (OR = 1.10) or >10 years (OR = 0.44-3.29) (An OR <1 indicates a predictor of lower risk of AIA). DISCUSSION Despite the established benefits of AI, an important portion of the patients experiences AIA. More research is needed to investigate the efficacy of treatments such as exercise therapy for AIA.
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Affiliation(s)
- David Beckwée
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Laurence Leysen
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Pain in Motion Research Group, Brussels, Belgium
| | - Kaipo Meuwis
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Nele Adriaenssens
- Rehabilitation Sciences Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
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Tan X, Camacho F, Marshall VD, Donohoe J, Anderson RT, Balkrishnan R. Geographic disparities in adherence to adjuvant endocrine therapy in Appalachian women with breast cancer. Res Social Adm Pharm 2016; 13:796-810. [PMID: 27641308 DOI: 10.1016/j.sapharm.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/07/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appalachia is a largely rural, mountainous, poor and underserved region of the United States. Adherence to adjuvant endocrine therapy among Appalachian women with breast cancer is suboptimal. OBJECTIVES To explore small-area geographic variations and clustering patterns of breast cancer patient adherence to adjuvant endocrine therapy and associated factors in Appalachia. METHODS In this retrospective study, we analyzed Medicare claims data linked with cancer registries from four Appalachian states (PA, OH, KY, and NC) in 2006-2008. We included adult women who were diagnosed with stage I-III, hormone-receptor positive, primary breast cancer and who newly started adjuvant endocrine therapy after the primary treatment for breast cancer. Hot spot analysis was conducted to explore geographic variations in adjuvant endocrine therapy adherence. Geographically weighted logistic regression (GWLR) was used to examine whether the impacts of factors associated with adherence varied across the region. RESULTS Breast cancer patients living in PA and OH showed higher adherence to adjuvant endocrine therapy than those living in KY and NC. We identified clusters of high adherence in most of PA but poor adherence in Erie County, PA and in Buncombe, Transylvania, Henderson, and Polk Counties, NC. Adherence to adjuvant endocrine therapy was significantly associated with the Health Professional Shortage Area designation, catastrophic coverage, dual-eligibility status of Medicaid and Medicare, adjuvant endocrine therapy drug class, and side effects. And among these factors, the impacts of dual-eligibility status and the use of pain medications to treat side effects on adherence were more pronounced in KY and NC than in PA. CONCLUSIONS There were significant geographic disparities in adherence to adjuvant endocrine therapy in the Appalachian counties in PA, OH, KY, and NC. This study explored these geographic areas with poor adherence as well as geographically varying effects of predictors on adherence; our results may provide more localized information that may be used to improve adjuvant therapy use and breast cancer care in these high-risk and underserved areas.
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Affiliation(s)
- Xi Tan
- West Virginia University, School of Pharmacy, Robert C. Byrd Health Sciences Center-North, P.O. Box 9510, Morgantown, WV 26505, USA
| | - Fabian Camacho
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Vincent D Marshall
- University of Michigan, College of Pharmacy, 428 Church Street, Ann Arbor, MI 48105, USA
| | - Joseph Donohoe
- Mountain-Pacific Quality Health, 3404 Cooney Drive, Helena, MT 59602, USA
| | - Roger T Anderson
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Rajesh Balkrishnan
- University of Virginia, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA.
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Téllez Bernal E, Falcón Flores O, Méndez Tamariz RM, Zalapa Velázquez R, Aguilar Priego JM, Mendoza López A. Prevalencia de artralgias y mialgias en pacientes con cáncer de mama en tratamiento con inhibidores de la aromatasa. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zarkavelis G, Kollas A, Kampletsas E, Vasiliou V, Kaltsonoudis E, Drosos A, Khaled H, Pavlidis N. Aromatase inhibitors induced autoimmune disorders in patients with breast cancer: A review. J Adv Res 2016; 7:719-726. [PMID: 28275510 PMCID: PMC5328027 DOI: 10.1016/j.jare.2016.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is characterized by particular cutaneous manifestations such as non-scaring plaques mainly in sunlight exposed parts of the body along with specific serum autoantibodies (i.e. antinuclear antibodies (ANA), Ro/SSa, La/SSb). It is considered either idiopathic or drug induced. The role of chemotherapeutic agents in causing SCLE has been investigated with the taxanes being the most common anticancer agents. However, recent data emerging point toward antiestrogen therapies as a causative factor not only for SCLE but also for a variety of autoimmune disorders. This is a report of a case of a 42 year old woman who developed clinical manifestations of SCLE after letrozole treatment in whom remission of the cutaneous manifestations was noticed upon discontinuation of the drug. In addition, an extensive review of the English literature has been performed regarding the association of antiestrogen therapy with autoimmune disorders. In conclusion, Oncologists should be aware of the potential development of autoimmune reactions in breast cancer patients treated with aromatase inhibitors.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Aristomenes Kollas
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Eleftherios Kampletsas
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Vasilis Vasiliou
- Department of Dermatology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Evripides Kaltsonoudis
- Rheumatology Clinic, Department of Internal Medicine, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Alexandros Drosos
- Rheumatology Clinic, Department of Internal Medicine, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Hussein Khaled
- Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
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The association between pre-treatment occupational skill level and mood and symptom burden in early-stage, postmenopausal breast cancer survivors during the first year of anastrozole therapy. Support Care Cancer 2016; 24:3401-9. [PMID: 26984246 DOI: 10.1007/s00520-016-3161-y] [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: 11/04/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Previous research has explored occupational activity of breast cancer survivors but has not examined the influence of occupational level on symptoms prospectively. The purpose of this study was to examine the relationship between occupational classification and changes in mood and symptom burden for postmenopausal breast cancer survivors during the first year of anastrozole therapy. METHODS This was an exploratory secondary analysis in 49 postmenopausal women receiving anastrozole therapy for early-stage breast cancer. Participants reported their occupation at baseline and completed self-report questionnaires measuring mood and symptom burden at baseline, 6 months, and 12 months. Occupation was classified according to four major skill levels delineated by the International Standard Classification of Occupations (ISCO). RESULTS Breast cancer survivors employed at occupational skill levels 1 through 3 reported significantly higher depressive symptoms, fatigue, and total symptoms on average than those employed at ISCO skill level 4. After adjusting for multiple comparisons, this pattern remained for the musculoskeletal, vasomotor, and gastrointestinal symptom subscales. CONCLUSIONS Breast cancer survivors employed at lower skill levels (i.e., ISCO 1-3) reported poorer mood and greater symptom burden than breast cancer survivors employed at a higher skill level (i.e., ISCO 4). Assessing baseline occupation of occupationally active breast cancer survivors may improve understanding of the association between types of occupations and mood and symptom trajectories and may inform development of interventions to mitigate symptom severity in order to help breast cancer survivors maintain optimal occupational function and adherence to therapy.
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The relationship of bone-tumor-induced spinal cord astrocyte activation and aromatase expression to mechanical hyperalgesia and cold hypersensitivity in intact female and ovariectomized mice. Neuroscience 2016; 324:344-54. [PMID: 26995084 DOI: 10.1016/j.neuroscience.2016.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/28/2022]
Abstract
Recently, our group established a relationship between tumor-induced spinal cord astrocyte activation and aromatase expression and the development of bone tumor nociception in male mice. As an extension of this work, we now report on the association of tumor-induced mechanical hyperalgesia and cold hypersensitivity to changes in spinal cord dorsal horn GFAP and aromatase expression in intact (INT) female mice and the effect of ovariectomy on these parameters. Implantation of fibrosarcoma cells produced robust mechanical hyperalgesia in INT animals, while ovariectomized (OVX) females had significantly less mechanical hyperalgesia. Cold hypersensitivity was apparent by post-implantation day 7 in INT and OVX females compared to their saline-injected controls and increased throughout the experiment. The decrease in mechanical hyperalgesia in OVX females was mirrored by significant decreases in spinal astrocyte activity in laminae I-II, III-IV, V-VI and X and aromatase expression in laminae V-VI and X in the dorsal horn of tumor-bearing animals. Administration of the aromatase inhibitor letrozole reduced tumor-induced hyperalgesia in INT females only suggesting that the tumor-induced increase in aromatase expression and its associated increase in spinal estrogen play a role in the development of bone tumor-induced hyperalgesia. Finally, intrathecal (i.t.) administration of 17β-estradiol caused a significant increase in tumor-induced hyperalgesia in INT tumor-bearing females. Since i.t. 17β-estradiol increases tumor pain and ovariectomy significantly decreases tumor pain, as well as spinal aromatase, estrogen may play a critical role in the spinal cord response to the changing tumor environment and the development of tumor-induced nociception.
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48
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Knobf MT, Jeon S, Smith B, Harris L, Kerstetter J, Thompson AS, Insogna K. Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy. Breast Cancer Res Treat 2016; 155:491-500. [DOI: 10.1007/s10549-016-3693-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Owens C, Andelkovic V, Pathmanathan S, Sanmugarajah J. Early discontinuation rates of aromatase inhibitors due to musculoskeletal side effects. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt.15.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We conducted a single institution retrospective review to assess early rates of discontinuation of aromatase inhibitors (AI) due to musculoskeletal adverse effects (MSKAEs) and response to switching to alternative hormonal agents. Patients & methods: A total of 139 patients on adjuvant AI were identified. In total, 41.7% reported MSKAE, with more than half requiring early discontinuation of treatment – 21.6% of initial cohort. Results & conclusion: Out of 30 patients who discontinued AI, six declined further treatment, nine switched to tamoxifen and 15 switched to alternative AI. Rate of symptom improvement were 67, 78 and 27%, respectively. Ten patients (66.7%) on second AI discontinued treatment due to MSKAEs. MSKAEs were the most commonly reported adverse effects leading to discontinuation of AI.
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Affiliation(s)
- Clare Owens
- Medical Oncology Department, Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Vladimir Andelkovic
- Medical Oncology Department, Gold Coast University Hospital, Southport, QLD 4215, Australia
| | | | - Jasotha Sanmugarajah
- Medical Oncology Department, Gold Coast University Hospital, Southport, QLD 4215, Australia
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Lv W, Liu J, Skaar TC, O'Neill E, Yu G, Flockhart DA, Cushman M. Synthesis of Triphenylethylene Bisphenols as Aromatase Inhibitors That Also Modulate Estrogen Receptors. J Med Chem 2015; 59:157-70. [PMID: 26704594 DOI: 10.1021/acs.jmedchem.5b01677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A series of triphenylethylene bisphenol analogues of the selective estrogen receptor modulator (SERM) tamoxifen were synthesized and evaluated for their abilities to inhibit aromatase, bind to estrogen receptor α (ER-α) and estrogen receptor β (ER-β), and antagonize the activity of β-estradiol in MCF-7 human breast cancer cells. The long-range goal has been to create dual aromatase inhibitor (AI)/selective estrogen receptor modulators (SERMs). The hypothesis is that in normal tissue the estrogenic SERM activity of a dual AI/SERM could attenuate the undesired effects stemming from global estrogen depletion caused by the AI activity of a dual AI/SERM, while in breast cancer tissue the antiestrogenic SERM activity of a dual AI/SERM could act synergistically with AI activity to enhance the antiproliferative effect. The potent aromatase inhibitory activities and high ER-α and ER-β binding affinities of several of the resulting analogues, together with the facts that they antagonize β-estradiol in a functional assay in MCF-7 human breast cancer cells and they have no E/Z isomers, support their further development in order to obtain dual AI/SERM agents for breast cancer treatment.
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Affiliation(s)
- Wei Lv
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - Jinzhong Liu
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Todd C Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Elizaveta O'Neill
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - Ge Yu
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
| | - David A Flockhart
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana 46202, United States
| | - Mark Cushman
- Department of Medicinal Chemistry and Molecular Pharmacology, College of Pharmacy, and The Purdue University Center for Cancer Research, Purdue University , West Lafayette, Indiana 47907, United States
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