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Hu X, Shen Y, Yang S, Lei W, Luo C, Hou Y, Bai G. Metabolite identification of ursolic acid in mouse plasma and urine after oral administration by ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry. RSC Adv 2018; 8:6532-6539. [PMID: 35540410 PMCID: PMC9078307 DOI: 10.1039/c7ra11856b] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Ursolic acid (UA), a pentacyclic terpenoid carboxylic acid widely existing in various medicinal plants, has been reported to have multifarious biological activities such as anti-inflammatory, anticancer and antioxidant activities. In this paper, we analyzed the metabolic profile of UA in mice (including plasma and urine) by using ultra-high performance liquid chromatography (UPLC) coupled with a quadrupole time-of-flight (Q/TOF) method. Principal component analysis (PCA) was applied to differentiate the control and experimental groups. Potential biomarkers were filtered by using loading plots followed by further analysis with UPLC-Q/TOF-MS data. The results showed that 3 metabolites in plasma were identified as markers, one of which was UA and the others were UA epoxides, which belonged to phase I metabolites. Additionally, 5 phase II metabolites were tentatively identified in urine through an accurate mass and characteristic fragment ions. These data suggested that the biotransformation of UA undergoes the major metabolic reactions of the phase I metabolic route of olefin oxidation and phase II metabolic routes of glycine conjugation, glutathione conjugation and glucuronidation. This is the first report of analysis and characterization of the metabolites after the oral administration of UA in mice. The proposed metabolic pathways of UA in mice is also raised for the first time. It might provide further understanding of the potential biological mechanism of UA. First report on metabolism study of ursolic acid (UA) in vivo of mice.![]()
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Affiliation(s)
- Xueyan Hu
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Yunbing Shen
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Shengnan Yang
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Wei Lei
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Cheng Luo
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Yuanyuan Hou
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
| | - Gang Bai
- State Key Laboratory of Medicinal Chemical Biology
- College of Pharmacy
- Tianjin Key Laboratory of Molecular Drug Research
- Nankai University
- Tianjin 300350
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Correction: Xie, H.; et al. 3D QSAR studies, pharmacophore modeling and virtual screening on a series of steroidal aromatase inhibitors. Int. J. Mol. Sci. 2014, 15, 20927-20947. Int J Mol Sci 2015; 16:5072-5. [PMID: 25751723 PMCID: PMC4394465 DOI: 10.3390/ijms16035072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 11/17/2022] Open
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3D QSAR studies, pharmacophore modeling and virtual screening on a series of steroidal aromatase inhibitors. Int J Mol Sci 2014; 15:20927-47. [PMID: 25405729 PMCID: PMC4264204 DOI: 10.3390/ijms151120927] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 12/12/2022] Open
Abstract
Aromatase inhibitors are the most important targets in treatment of estrogen-dependent cancers. In order to search for potent steroidal aromatase inhibitors (SAIs) with lower side effects and overcome cellular resistance, comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) were performed on a series of SAIs to build 3D QSAR models. The reliable and predictive CoMFA and CoMSIA models were obtained with statistical results (CoMFA: q2 = 0.636, r2ncv = 0.988, r2pred = 0.658; CoMSIA: q2 = 0.843, r2ncv = 0.989, r2pred = 0.601). This 3D QSAR approach provides significant insights that can be used to develop novel and potent SAIs. In addition, Genetic algorithm with linear assignment of hypermolecular alignment of database (GALAHAD) was used to derive 3D pharmacophore models. The selected pharmacophore model contains two acceptor atoms and four hydrophobic centers, which was used as a 3D query for virtual screening against NCI2000 database. Six hit compounds were obtained and their biological activities were further predicted by the CoMFA and CoMSIA models, which are expected to design potent and novel SAIs.
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Xie H, Qiu K, Xie X. Pharmacophore modeling, virtual screening, and 3D-QSAR studies on a series of non-steroidal aromatase inhibitors. Med Chem Res 2014. [DOI: 10.1007/s00044-014-1257-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Varela CL, Roleira FMF, Costa SCP, Pinto ASCT, Martins AIOS, Carvalho RA, Teixeira NA, Correia-da-Silva G, Tavares-da-Silva E. Insights into the Synthesis of SteroidalA-Ring Olefins. Helv Chim Acta 2014. [DOI: 10.1002/hlca.201300082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Walker G, Kaidar-Person O, Kuten A, Morgan D. Radiotherapy as sole adjuvant treatment for older patients with low-risk breast cancer. Breast 2012; 21:629-34. [DOI: 10.1016/j.breast.2012.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/15/2012] [Accepted: 06/08/2012] [Indexed: 11/29/2022] Open
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Varela C, Tavares da Silva EJ, Amaral C, Correia da Silva G, Baptista T, Alcaro S, Costa G, Carvalho RA, Teixeira NAA, Roleira FMF. New Structure–Activity Relationships of A- and D-Ring Modified Steroidal Aromatase Inhibitors: Design, Synthesis, and Biochemical Evaluation. J Med Chem 2012; 55:3992-4002. [DOI: 10.1021/jm300262w] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carla Varela
- CEF, Center
for Pharmaceutical
Studies, Pharmaceutical Chemistry Group, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Elisiário J. Tavares da Silva
- CEF, Center
for Pharmaceutical
Studies, Pharmaceutical Chemistry Group, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Cristina Amaral
- Biochemistry Laboratory, Faculty
of Pharmacy, University of Porto, Rua Jorge
Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Institute for Molecular and Cellular
Biology (IBMC), University of Porto, Rua
do Campo Alegre, 823, 4150-180 Porto, Portugal
| | - Georgina Correia da Silva
- Biochemistry Laboratory, Faculty
of Pharmacy, University of Porto, Rua Jorge
Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Institute for Molecular and Cellular
Biology (IBMC), University of Porto, Rua
do Campo Alegre, 823, 4150-180 Porto, Portugal
| | - Teresa Baptista
- CEF, Center for Pharmaceutical
Studies, Bromatology, Pharmacognosy and Analytical Sciences Group,
Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Stefano Alcaro
- CCLab, Dipartimento di Scienze
della Salute, Università “Magna Græcia” di Catanzaro, Italy
| | - Giosuè Costa
- CCLab, Dipartimento di Scienze
della Salute, Università “Magna Græcia” di Catanzaro, Italy
| | - Rui A. Carvalho
- Department of Life Sciences, Faculty
of Science and Technology, University of Coimbra, Portugal
| | - Natércia A. A. Teixeira
- Biochemistry Laboratory, Faculty
of Pharmacy, University of Porto, Rua Jorge
Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Institute for Molecular and Cellular
Biology (IBMC), University of Porto, Rua
do Campo Alegre, 823, 4150-180 Porto, Portugal
| | - Fernanda M. F. Roleira
- CEF, Center
for Pharmaceutical
Studies, Pharmaceutical Chemistry Group, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
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Patient and Provider Determinants Associated With the Prescription of Adjuvant Hormonal Therapies Following a Diagnosis of Breast Cancer in Medicaid-Enrolled Patients. J Natl Med Assoc 2009; 101:1112-8. [DOI: 10.1016/s0027-9684(15)31106-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Editorial. Optimizing breast cancer patient care today and tomorrow: implications for clinicians. Breast Cancer Res Treat 2008; 112 Suppl 1:1-3. [PMID: 19101791 DOI: 10.1007/s10549-008-0247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cepa MMDS, Tavares da Silva EJ, Correia-da-Silva G, Roleira FMF, Teixeira NAA. Synthesis and biochemical studies of 17-substituted androst-3-enes and 3,4-epoxyandrostanes as aromatase inhibitors. Steroids 2008; 73:1409-15. [PMID: 18691607 DOI: 10.1016/j.steroids.2008.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 07/02/2008] [Accepted: 07/09/2008] [Indexed: 11/26/2022]
Abstract
A series of 5alpha-androst-3-enes and 3alpha,4alpha-epoxy-5alpha-androstanes were synthesized and tested for their abilities to inhibit aromatase in human placental microsomes. In these series the original C-17 carbonyl group was replaced by hydroxyl, acetyl and hydroxyimine groups. Inhibition kinetic analysis on the most potent steroid of these series revealed that it inhibits the enzyme in a competitive manner (IC(50)=6.5 microM). The achieved data pointed out the importance of the C-17 carbonyl group in the D-ring of the studied steroids as a structural feature required to reach maximum aromatase inhibitory activity. Further, at least one carbonyl group (C-3 or C-17) seems to be essential to effective aromatase inhibition.
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Affiliation(s)
- Margarida M D S Cepa
- Biochemistry Laboratory, Faculty of Pharmacy, University of Porto, Rua Aníbal Cunha 164, 4099-030 Porto, Portugal
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Hernandez RK, Sørensen HT, Jacobsen J, Pedersen L, Lash TL. Tamoxifen treatment in Danish breast cancer patients and 5-year risk of arterial atherosclerotic events: a null association. Cancer Epidemiol Biomarkers Prev 2008; 17:2509-11. [PMID: 18768523 DOI: 10.1158/1055-9965.epi-08-0570] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the effectiveness of tamoxifen in preventing the recurrence of breast cancer is well established, associations between tamoxifen and the occurrence of atherosclerotic events are not as clear. Breast cancer patients taking tamoxifen have lower serum cholesterol and other lipid levels than those not taking tamoxifen, suggesting that tamoxifen might prevent atherosclerotic events, but the existing studies are conflicting. We examined the relation between tamoxifen and incident hospitalization of angina pectoris, acute myocardial infarction, heart failure, and stroke. The study population of 16,289 women was identified from the Danish Breast Cancer Cooperative Group nationwide clinical database and includes women diagnosed with stage I or II estrogen receptor-positive breast cancer between 1990 and 2004 at ages 45 to 69. Use of a large population-based sample with complete outcome ascertainment allowed us to calculate precise measures of risks, risk ratios, and adjusted hazard ratios comparing tamoxifen-treated patients with untreated patients. We found strong evidence for null associations for each of the four outcomes of interest during the first year and first 5 years after the start of therapy. These findings are important in risk/benefit analyses as tamoxifen therapy in postmenopausal women is being replaced with aromatase inhibitors.
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Affiliation(s)
- Rohini K Hernandez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Lézé MP, Palusczak A, Hartmann RW, Le Borgne M. Synthesis of 6- or 4-functionalized indoles via a reductive cyclization approach and evaluation as aromatase inhibitors. Bioorg Med Chem Lett 2008; 18:4713-5. [DOI: 10.1016/j.bmcl.2008.06.094] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 06/27/2008] [Accepted: 06/28/2008] [Indexed: 10/21/2022]
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Cepa M, Correia-da-Silva G, da Silva EJT, Roleira FMF, Borges M, Teixeira NA. New steroidal aromatase inhibitors: suppression of estrogen-dependent breast cancer cell proliferation and induction of cell death. BMC Cell Biol 2008; 9:41. [PMID: 18652661 PMCID: PMC2515307 DOI: 10.1186/1471-2121-9-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 07/24/2008] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Aromatase, the cytochrome P-450 enzyme (CYP19) responsible for estrogen biosynthesis, is an important target for the treatment of estrogen-dependent breast cancer. In fact, the use of synthetic aromatase inhibitors (AI), which induce suppression of estrogen synthesis, has shown to be an effective alternative to the classical tamoxifen for the treatment of postmenopausal patients with ER-positive breast cancer. New AIs obtained, in our laboratory, by modification of the A and D-rings of the natural substrate of aromatase, compounds 3a and 4a, showed previously to efficiently suppress aromatase activity in placental microsomes. In the present study we have investigated the effects of these compounds on cell proliferation, cell cycle progression and induction of cell death using the estrogen-dependent human breast cancer cell line stably transfected with the aromatase gene, MCF-7 aro cells. RESULTS The new steroids inhibit hormone-dependent proliferation of MCF-7aro cells in a time and dose-dependent manner, causing cell cycle arrest in G0/G1 phase and inducing cell death with features of apoptosis and autophagic cell death. CONCLUSION Our in vitro studies showed that the two steroidal AIs, 3a and 4a, are potent inhibitors of breast cancer cell proliferation. Moreover, it was also shown that the antiproliferative effects of these two steroids on MCF-7aro cells are mediated by disrupting cell cycle progression, through cell cycle arrest in G0/G1 phase and induction of cell death, being the dominant mechanism autophagic cell death. Our results are important for the elucidation of the cellular effects of steroidal AIs on breast cancer.
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Affiliation(s)
- Margarida Cepa
- Biochemistry Laboratory, Faculty of Pharmacy, University of Oporto, Rua Aníbal Cunha, 164, 4099-030 Oporto, Portugal
- IBMC – Institute for Molecular and Cellular Biology, University of Oporto, 4150-180 Oporto, Portugal
| | - Georgina Correia-da-Silva
- Biochemistry Laboratory, Faculty of Pharmacy, University of Oporto, Rua Aníbal Cunha, 164, 4099-030 Oporto, Portugal
- IBMC – Institute for Molecular and Cellular Biology, University of Oporto, 4150-180 Oporto, Portugal
| | - Elisiário J Tavares da Silva
- Centro de Estudos Farmacêuticos, Pharmaceutical Chemistry Laboratory, Faculty of Pharmacy, University of Coimbra, 3000-295 Coimbra, Portugal
| | - Fernanda MF Roleira
- Centro de Estudos Farmacêuticos, Pharmaceutical Chemistry Laboratory, Faculty of Pharmacy, University of Coimbra, 3000-295 Coimbra, Portugal
| | - Margarida Borges
- Biochemistry Laboratory, Faculty of Pharmacy, University of Oporto, Rua Aníbal Cunha, 164, 4099-030 Oporto, Portugal
- IBMC – Institute for Molecular and Cellular Biology, University of Oporto, 4150-180 Oporto, Portugal
| | - Natércia A Teixeira
- Biochemistry Laboratory, Faculty of Pharmacy, University of Oporto, Rua Aníbal Cunha, 164, 4099-030 Oporto, Portugal
- IBMC – Institute for Molecular and Cellular Biology, University of Oporto, 4150-180 Oporto, Portugal
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Albrand G, Terret C. Early breast cancer in the elderly: assessment and management considerations. Drugs Aging 2008; 25:35-45. [PMID: 18184027 DOI: 10.2165/00002512-200825010-00004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Breast cancer is a common tumour in the elderly and management of early disease in particular is a major challenge for oncologists and geriatricians alike. The process should begin with the Comprehensive Geriatric Assessment (CGA), which should be undertaken before any decisions about treatment are made. The important role of co-morbidities and their effect on life expectancy also need to be taken into account when making treatment decisions. The primary treatments for early breast cancer are surgery, adjuvant radiotherapy and adjuvant systemic therapy. Unfortunately, lack of a specific literature relating to early breast cancer in the elderly means formulating an evidence-based approach to treatment in this context is difficult. We have developed a new approach based on the CGA and comprehensive oncological assessment. This approach facilitates the development of an individualized oncogeriatric care plan and follow-up based on several considerations: the average patient's life expectancy at a given age; the patient's co-morbidities, level of dependence, and the impact of these considerations on diagnostic and therapeutic options as well as life expectancy; and the potential benefit-risk balance of treatment. In the elderly patient with breast cancer, the standard primary therapy is surgical resection (mastectomy or breast-conserving therapy). While node dissection is a major component of staging and local control of breast cancer, no data are available to guide decision-making in women aged >70 years. Primary endocrine therapy (tamoxifen) should be offered to elderly women with estrogen receptor (ER)-positive breast cancer only if they are unfit for or refuse surgery. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for infirm older patients with ER-positive tumours. Breast irradiation should be recommended to older women with a life expectancy >5 years, particularly those with large tumours, positive lymph nodes or negative hormone receptors. Adjuvant hormone therapy remains a reasonable therapeutic option in elderly women with positive hormone receptor tumours. Aromatase inhibitors have demonstrated a better toxicity profile and effectiveness as adjuvant therapy than tamoxifen in young postmenopausal women but have not been specifically studied in the elderly population. The efficacy of adjuvant chemotherapy for breast cancer has been established by meta-analysis and numerous randomized trials but, again, women aged > or = 70 years have rarely been included in such trials. At present, it is difficult to provide a validated recommendation for use of adjuvant chemotherapy in elderly patients with breast cancer. There are no follow-up recommendations specifically for elderly patients after treatment of early breast cancer. However, American Society of Clinical Oncology breast cancer surveillance guidelines suggest physician office visits every 3-6 months for 3 years, followed by visits every 6-12 months for 2 years, then annually. Women taking aromatase inhibitors should also undergo bone mineral density measurement every 2 years. The new approach to assessment and management of early breast cancer in the elderly outlined in this article should be considered an intermediate step because additional evidence to support clinical practice is still needed. Bearing this in mind, physicians should encourage enrollment of elderly breast cancer patients in clinical trials.
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Affiliation(s)
- Gilles Albrand
- Hôpital Geriatrique Antoine Charial, Hospices Civils de Lyon, Programme Lyonnais d'Onco-gériatrie (PROLOG), Francheville, France.
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Annemans L. Methodological issues in evaluating cost effectiveness of adjuvant aromatase inhibitors in early breast cancer: a need for improved modelling to aid decision making. PHARMACOECONOMICS 2008; 26:409-23. [PMID: 18429657 DOI: 10.2165/00019053-200826050-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The optimal adjuvant hormonal strategy in post-menopausal women with early breast cancer is a subject of ongoing debate. Aromatase inhibitors (AIs) have been successfully evaluated in clinical trials that have compared them with a standard treatment of 5 years of tamoxifen. However, several options are available in terms of treatment schedule and selected drug. Systematic reviews of clinical trials and health economic evaluations attempt to contribute to the debate. The objective of this paper is to provide a critical review of existing health economic evaluations with a focus on those parameters and assumptions with the largest impact on final outcomes.A wide range of different inputs and assumptions exist, which make a comparison of results difficult, if not impossible. In particular, the modelling of recurrence rates over longer time horizons than those observed in clinical trials, a cornerstone of health economic modelling, is subject to quite different approaches. The practice of indirect comparison of different AIs without sufficiently acknowledging population differences is also bothersome. A list of key features (related to time horizon, clinical data input, patient subtypes, budget impact and model calibration) that an ideal model should have in order to better assist decision makers in this field is proposed.
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Affiliation(s)
- Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium.
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Abstract
PURPOSE OF REVIEW This review examines recent data on the pathophysiology and mechanisms of bone pain; it highlights the use of multiple and interdisciplinary treatments rather than sole use of traditional analgesics. RECENT FINDINGS Bone pain has been shown to have a unique pathophysiology. Recent experimental (animal) models have revealed that, parallel to increased bone destruction, ipsilateral spinal cord segments that receive primary input from the cancerous femur exhibit several notable neurochemical changes. These mandate the use of opioid doses sufficient to inhibit the observed nociceptive behaviours; these doses are greater than those required to alleviate pain behaviours of comparable magnitude generated by inflammatory pain. Several substances have been tested in this animal model. SUMMARY According to new preclinical data, treatment of bone cancer pain requires multidisciplinary therapies such as radiotherapy applied to the painful area along with systemic treatment (hormone therapy or chemotherapy) and supportive care (analgesic therapy and bisphosphonates). In some selected cases use of radioisotopes and other noninvasive or minimally invasive techniques may be useful in the management of metastatic bone pain. The treatment should be individualized according to the patient's clinical condition, life expectancy, and quality of life.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia & Intensive Care Unit - La Maddalena Cancer Center, University of Palermo, Palermo, Italy.
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