1
|
Li X, Hou X, Hernández-Wolters B, Prabahar K, Kord-Varkaneh H, Mei B. The effect of tamoxifen on estradiol, SHBG, IGF-1, and CRP in women with breast cancer or at risk of developing breast cancer: a meta-analysis of randomized controlled trials. Exp Gerontol 2024; 191:112431. [PMID: 38608792 DOI: 10.1016/j.exger.2024.112431] [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] [Received: 02/06/2024] [Revised: 03/07/2024] [Accepted: 04/10/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND AIM The effects of tamoxifen on the serum levels of hormones and acute phase reactants have been studied previously, but study results have been inconsistent, especially in women with breast cancer. Hence, we conducted this meta-analysis of randomized controlled trials (RCTs) to try to clarify the effects of tamoxifen on estradiol, insulin-like growth factor 1 (IGF-1), sex hormone binding globulin (SHBG), and C-reactive protein (CRP) serum levels in women with breast cancer or at risk of developing breast cancer. METHODS Databases were systematically searched up to December 2023. The meta-analysis was generated through a random-effects model and is presented as the weighted mean difference (WMD) and 95 % confidence intervals (CI). RESULTS Nine publications were included in the present meta-analysis. The comprehensive findings from the random-effects model revealed an elevation in estradiol (WMD: 13.04 pg/mL, 95 % CI: 0.79, 25.30, p = 0.037) and SHBG levels (WMD: 21.26 nmol/l, 95 % CI: 14.85, 27.68, p = 0.000), as well as a reduction in IGF-1 (WMD: -14.41 μg/L, 95 % CI: -24.23, -4.60, p = 0.004) and CRP concentrations (WMD: -1.17 mg/dL, 95 % CI: -2.29, -0.05, p = 0.039) following treatment with tamoxifen in women with breast cancer or at risk of developing breast cancer, with no impact on IGFBP-3 levels (WMD: 0.11 μg/mL, 95 % CI: -0.07, 0.30, p = 0.240). CONCLUSION Tamoxifen administration seems to increase estradiol and SHBG levels and reduce CRP and IGF-1 levels in women with breast cancer or at risk of developing breast cancer. Further studies are needed to determine whether these changes have any clinical relevance.
Collapse
Affiliation(s)
- XingDa Li
- Department of Oncology, 967th Hospital of the Joint Logistics Support Force of PLA, Dalian 116021, China
| | - XueJiao Hou
- Department of Oncology, 967th Hospital of the Joint Logistics Support Force of PLA, Dalian 116021, China
| | | | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Hamed Kord-Varkaneh
- Department of Nutrition and Food Hygiene, School of Medicine, Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Bo Mei
- Department of Oncology, 967th Hospital of the Joint Logistics Support Force of PLA, Dalian 116021, China.
| |
Collapse
|
2
|
Hultsch S, Kankainen M, Paavolainen L, Kovanen RM, Ikonen E, Kangaspeska S, Pietiäinen V, Kallioniemi O. Association of tamoxifen resistance and lipid reprogramming in breast cancer. BMC Cancer 2018; 18:850. [PMID: 30143015 PMCID: PMC6109356 DOI: 10.1186/s12885-018-4757-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/16/2018] [Indexed: 12/03/2022] Open
Abstract
Background Tamoxifen treatment of estrogen receptor (ER)-positive breast cancer reduces mortality by 31%. However, over half of advanced ER-positive breast cancers are intrinsically resistant to tamoxifen and about 40% will acquire the resistance during the treatment. Methods In order to explore mechanisms underlying endocrine therapy resistance in breast cancer and to identify new therapeutic opportunities, we created tamoxifen-resistant breast cancer cell lines that represent the luminal A or the luminal B. Gene expression patterns revealed by RNA-sequencing in seven tamoxifen-resistant variants were compared with their isogenic parental cells. We further examined those transcriptomic alterations in a publicly available patient cohort. Results We show that tamoxifen resistance cannot simply be explained by altered expression of individual genes, common mechanism across all resistant variants, or the appearance of new fusion genes. Instead, the resistant cell lines shared altered gene expression patterns associated with cell cycle, protein modification and metabolism, especially with the cholesterol pathway. In the tamoxifen-resistant T-47D cell variants we observed a striking increase of neutral lipids in lipid droplets as well as an accumulation of free cholesterol in the lysosomes. Tamoxifen-resistant cells were also less prone to lysosomal membrane permeabilization (LMP) and not vulnerable to compounds targeting the lipid metabolism. However, the cells were sensitive to disulfiram, LCS-1, and dasatinib. Conclusion Altogether, our findings highlight a major role of LMP prevention in tamoxifen resistance, and suggest novel drug vulnerabilities associated with this phenotype. Electronic supplementary material The online version of this article (10.1186/s12885-018-4757-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Susanne Hultsch
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland.
| | - Matti Kankainen
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Lassi Paavolainen
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Ruusu-Maaria Kovanen
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Elina Ikonen
- Department of Anatomy, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sara Kangaspeska
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland.,Helsinki Innovation Services (HIS), Helsinki, Finland
| | - Vilja Pietiäinen
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland, FIMM, Helsinki Institute for Life Sciences (HiLIFE), University of Helsinki, Helsinki, Finland.,Department of Oncology and Pathology, Karolinska Institute and the Science for Life Laboratory (SciLifeLab), Solna, Sweden
| |
Collapse
|
3
|
Pasta V, Dinicola S, Giuliani A, Harrath AH, Alwasel SH, Tartaglia F, Cucina A, Bizzarri M. A Randomized Pilot Study of Inositol in Association with Betaine and Boswellia in the Management of Mastalgia and Benign Breast Lump in Premenopausal Women. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:37-43. [PMID: 27127407 PMCID: PMC4839963 DOI: 10.4137/bcbcr.s38408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Abstract
Benign mammary lumps and mastalgia are the most common breast disorders; yet, there is no clear-cut consensus about the best strategy for their treatment. We hypothesized that a combination, including boswellic acid, betaine, and myoinositol, would be beneficial in breast disorders by exerting a pleiotropic effect on multiple pathways. Indeed, myoinositol has already been proven to modulate some factors involved in the genesis of breast diseases, such as fibrosis and metabolic and endocrine cues. In our study, 76 women were randomly assigned to either the experimental or the placebo arm. After six months of treatment, statistically significant differences between the two groups were recorded for pain relief (56% vs 17%) and breast density reduction (60% vs 9%). Furthermore, benign breast mass dimension showed a reduction in the experimental group (40% vs 16%). The combination of boswellic acid, betaine, and myoinositol has been demonstrated to be effective in the treatment of breast pain and radiologically and histologically confirmed benign breast mass and in the reduction of breast density, one of the pivotal risk factors for the development of breast cancer, without any side effects.
Collapse
Affiliation(s)
- Vittorio Pasta
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.; Azienda Policlinico Umberto I, Rome, Italy
| | - Simona Dinicola
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Alessandro Giuliani
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Abdel Halim Harrath
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saleh H Alwasel
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Francesco Tartaglia
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.; Azienda Policlinico Umberto I, Rome, Italy
| | - Alessandra Cucina
- Azienda Policlinico Umberto I, Rome, Italy.; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Mariano Bizzarri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.; Systems Biology Group Lab, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Carmichael AR. Can Vitex Agnus Castus be Used for the Treatment of Mastalgia? What is the Current Evidence? EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 5:247-50. [PMID: 18830450 PMCID: PMC2529385 DOI: 10.1093/ecam/nem074] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 05/18/2007] [Indexed: 11/18/2022]
Abstract
There have been many treatments suggested for the management of mastalgia; one of these is the fruit extract of Vitex Agnus castus L. commonly known as Agnus castus, an extract of a deciduous shrub native to Mediterranean Europe and Central Asia. It is postulated that A. castus suppresses the stress-induced latent hyperprolactinemia which is a release of supra-physiological levels of prolactin in some patients in response to stressful stimuli. It is postulated that A. castus could be effective in the treatment of cyclical mastalgia by inhibiting the release of excess prolactin by blocking Dopamine-2 receptor type on pituitary. The adverse events following A. castus treatment are mild and reversible. The aim of this review is assess the efficacy of A. castus in the treatment of mastalgia. Data from randomized and non-randomized studies regarding the efficacy and safety of A. castus is reviewed in a systematic fashion. It is concluded that A. castus can be considered as an efficient alternative phytotherapeutic agent in the treatment of mastalgia.
Collapse
Affiliation(s)
- A R Carmichael
- Russells Hall Hospital, Dudley DY1 2HQ, West Midlands, UK
| |
Collapse
|
5
|
Lønning PE. Evolution of endocrine adjuvant therapy for early breast cancer. Expert Opin Investig Drugs 2010; 19 Suppl 1:S19-30. [DOI: 10.1517/13543781003714865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
6
|
Premkumar A, Venzon DJ, Avila N, Johnson DV, Remaley AT, Forman MR, Eng-Wong J, Zujewski J, Stratton P. Gynecologic and hormonal effects of raloxifene in premenopausal women. Fertil Steril 2007; 88:1637-44. [PMID: 17662283 DOI: 10.1016/j.fertnstert.2007.01.095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 01/12/2007] [Accepted: 01/12/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effects of raloxifene on the ovaries, uterus, and serum hormone levels in premenopausal women. DESIGN Prospective study comparing pretreatment findings with findings for those on treatment. SETTING Government research hospital. PATIENT(S) Thirty women 35 to 47 years of age who were at high risk of breast cancer and had regular, ovulatory menstrual cycles. INTERVENTION(S) Raloxifene (60 mg) and calcium (1,200 mg) daily for 2 years. MAIN OUTCOME MEASURE(S) Sonographic evidence of ovarian stimulation (>or=2 corpora lutea, or follicular cysts of >2 cm, or single follicular cyst of >3 cm). Changes in endometrial thickness, fibroid size, hormone levels, and menstrual-cycle length. RESULT(S) Fifteen subjects developed some cycles with asymptomatic ovarian stimulation, and 9 developed benign endometrial polyps, compared with 2 subjects and 1 subject pretreatment, respectively. Uterine fibroid size was unchanged during raloxifene use in 16 subjects with fibroids. On treatment, E(2) levels increased significantly only during the follicular phase, with peak E(2) levels significantly higher in cycles showing ovarian stimulation compared with those without. Sex hormone-binding globulin increased, but levels of LH, FSH, P, DHEAS, and T did not. Endometrial thickness and cycle length were unchanged. CONCLUSION(S) Premenopausal subjects receiving raloxifene showed sonographic and hormonal evidence of ovarian stimulation. Endometrial thickness, cycle length, and fibroid size were unchanged. Benign asymptomatic endometrial polyps developed in some.
Collapse
Affiliation(s)
- Ahalya Premkumar
- Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, Bethesda, Maryland, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
Endocrine therapy plays a pivotal role in the early treatment of estrogen receptor (ER)-positive breast cancer. Although evidence suggests that chemotherapy may work partly through ovarian ablation in young women who have ER-positive tumors, combined chemotherapy and endocrine therapy are generally advocated. In postmenopausal women, aromatase inhibition has become the new "gold standard" of treatment. More research is needed to define optimal regimens (aromatase inhibitor monotherapy versus tamoxifen sequential application), optimal duration of therapy and potential advantages of particular compounds. The optimal use of estrogen suppression (ovarian ablation with or without aromatase inhibition) and tamoxifen (administered sequentially or in concert with ovarian ablation) in premenopausal women has yet to be defined.
Collapse
Affiliation(s)
- Per Eystein Lønning
- Section of Oncology, Department of Oncology, Institute of Medicine, University of Bergen, Haukeland University Hospital, N-5021 Bergen, Norway.
| |
Collapse
|
8
|
Issandou M. Pharmacological regulation of low density lipoprotein receptor expression: Current status and future developments. Pharmacol Ther 2006; 111:424-33. [PMID: 16423404 DOI: 10.1016/j.pharmthera.2005.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 10/24/2005] [Indexed: 01/22/2023]
Abstract
Plasma levels of low-density lipoprotein (LDL) cholesterol are considered to be a major risk factor for the development of cardiovascular diseases. The LDL receptor is the key component in the maintenance of cholesterol homeostasis in the body, playing a pivotal role by regulating the hepatic catabolism of LDL cholesterol. Many clinical studies using statins, which up-regulate the LDL receptor expression via a feedback mechanism, have demonstrated that the reduction of LDL cholesterol levels lowers the incidence of cardiovascular events in both primary and secondary prevention. In this context, new strategies designed to increase hepatic LDL receptor activity can be considered as attractive opportunities for future therapy. Several potential new drugs have been described in the last decade to up-regulate LDL receptor expression in vitro and in vivo, thus allowing the identification of new transcriptional and post-transcriptional mechanisms.
Collapse
Affiliation(s)
- Marc Issandou
- GlaxoSmithKline, 25 Avenue du Quebec, 91951 Les Ulis Cedex, France.
| |
Collapse
|
9
|
Vehmanen L, Saarto T, Blomqvist C, Taskinen MR, Elomaa I. Tamoxifen treatment reverses the adverse effects of chemotherapy-induced ovarian failure on serum lipids. Br J Cancer 2004; 91:476-81. [PMID: 15266329 PMCID: PMC2409844 DOI: 10.1038/sj.bjc.6601979] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In all, 146 premenopausal women with early stage breast cancer were treated with adjuvant chemotherapy. In addition, 5-year tamoxifen treatment was started after chemotherapy to those 112 patients with hormone-receptor-positive tumours while those with hormone-receptor-negative tumours received no further therapy. The serum lipid levels were followed in both groups. The levels of serum total and low-density lipoprotein (LDL) cholesterol increased significantly after chemotherapy only in patients who developed ovarian dysfunction. Total cholesterol increased +9.5% and LDL cholesterol +16.6% in patients who developed amenorrhoea (P<0.00001 and 0.00001, respectively). The cholesterol levels did not change in patients who preserved regular menstruation after chemotherapy. After 6 months of tamoxifen therapy, the total cholesterol decreased −9.7% and the LDL cholesterol −16.7% from levels after the chemotherapy, while the cholesterol concentrations remained at increased levels in the control group (P=0.001 and P<0.0001, respectively). The high-density lipoprotein cholesterol levels did not change significantly in either tamoxifen or control group. The effects of tamoxifen treatment on serum lipids after chemotherapy have not been studied before. Our current study suggests that adjuvant tamoxifen therapy reverses the adverse effects of chemotherapy-induced ovarian failure on total and LDL cholesterol and even lowers their serum levels below the baseline.
Collapse
Affiliation(s)
- L Vehmanen
- Department of Oncology, Helsinki University Central Hospital, PO BOX 180, HUCH, FIN-00290, Helsinki, Finland
| | - T Saarto
- Department of Oncology, Helsinki University Central Hospital, PO BOX 180, HUCH, FIN-00290, Helsinki, Finland
| | - C Blomqvist
- Department of Oncology, Helsinki University Central Hospital, PO BOX 180, HUCH, FIN-00290, Helsinki, Finland
| | - M-R Taskinen
- Department of Medicine, Helsinki University Central Hospital, FIN-00290, Helsinki, Finland
| | - I Elomaa
- Department of Oncology, Helsinki University Central Hospital, PO BOX 180, HUCH, FIN-00290, Helsinki, Finland
- Department of Oncology, Helsinki University Central Hospital, PO BOX 180, HUCH, FIN-00290, Helsinki, Finland. E-mail:
| |
Collapse
|
10
|
Abstract
Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed.
Collapse
Affiliation(s)
- Robin L Smith
- Breast Diagnostic Clinic, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
| | | | | |
Collapse
|
11
|
Cushman M, Costantino JP, Bovill EG, Wickerham DL, Buckley L, Roberts JD, Krag DN. Effect of tamoxifen on venous thrombosis risk factors in women without cancer: the Breast Cancer Prevention Trial. Br J Haematol 2003; 120:109-16. [PMID: 12492585 DOI: 10.1046/j.1365-2141.2003.03976.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tamoxifen reduces breast cancer incidence among healthy women, but is associated with an increased risk of venous thrombosis. We studied the 6 month effects of tamoxifen on venous thrombosis risk factors in women without cancer. One hundred and eleven women at one centre who were participants in a multicentre breast cancer prevention trial were randomized, in double-blind fashion, to receive 20 mg/d of tamoxifen or placebo. The activated protein C (APC) ratio and concentrations of antithrombin, protein C antigen, and total protein S were measured at baseline and 6 months of treatment. None of the factors changed over 6 months in placebo-treated women. Among tamoxifen-treated women, antithrombin and protein S, but not protein C or APC ratio were reduced. Sequential antithrombin concentrations with tamoxifen were 114% and 104% (P = 0.001 compared with placebo). Sequential protein S concentrations with tamoxifen were 18.42 and 17.30 micro g/ml (P = 0.02 compared with placebo). Reductions in antithrombin and protein S were greater in postmenopausal women, but did not differ by other risk factors for venous thrombosis, such as body mass index. Reductions of antithrombin and protein S, but not protein C or APC resistance, might relate to the increased risk of venous thrombosis associated with tamoxifen treatment.
Collapse
Affiliation(s)
- Mary Cushman
- Department of Medicine, University of Vermont, Burlington, VT, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Herrington DM, Klein KP. Effects of SERMs on important indicators of cardiovascular health: lipoproteins, hemostatic factors, and endothelial function. Womens Health Issues 2001; 11:95-102. [PMID: 11275512 DOI: 10.1016/s1049-3867(01)00075-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D M Herrington
- Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | |
Collapse
|
13
|
Lien EA, Lønning PE. Selective oestrogen receptor modifiers (SERMs) and breast cancer therapy. Cancer Treat Rev 2000; 26:205-27. [PMID: 10814562 DOI: 10.1053/ctrv.1999.0162] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antioestrogen therapy is currently receiving renewed interest for several reasons. Tamoxifen was introduced in the treatment of metastatic breast cancer more than three decades ago. The drug significantly reduces long term mortality and also reduces the risk of contralateral tumours when administered in early breast cancer. Five years of tamoxifen is now standard in adjuvant endocrine therapy, and the drug is currently being evaluated for breast cancer prevention. Despite this, several aspects regarding the pharmacology of the drug are still unclear, and the scientific rationale for dose selection has recently been challenged. Several novel antioestrogen compounds, called selective oestrogen receptor modifiers (SERMs), express selective oestrogen agonistic or antagonistic properties depending on the organ or test system evaluated. Some of these drugs, like raloxifene, do not seem to promote the development of endometrial cancer, although they still have selected oestrogen-like beneficial effects. This paper reviews the pharmacologic and the pharmacokinetic aspects of the different SERMs with particular emphasis on their potential use in therapy and prevention of breast cancer.
Collapse
Affiliation(s)
- E A Lien
- Department of Biochemical Endocrinology, Section of Oncology, Haukeland University Hospital, Bergens, N-5021, Norway
| | | |
Collapse
|
14
|
Spencer CP, Morris EP, Rymer JM. Selective estrogen receptor modulators: Women's panacea for the next millennium? Am J Obstet Gynecol 1999; 180:763-70. [PMID: 10076160 DOI: 10.1016/s0002-9378(99)70285-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this review is to assimilate relevant experimental and clinical information available on selective estrogen receptor modulators with respect to their potential use as agents to improve women's health in the postmenopausal years. In addition, the mechanisms of action of these drugs are outlined. Selective estrogen receptor modulators represent an exciting group of antiestrogens that possess agonist action on bone, lipids, and lipoproteins and antagonistic action in the endometrium and breast. Thus in theory these drugs may preserve bone density and reduce the risk of osteoporotic fracture and coronary heart disease at the same time that they lower the incidences of breast and endometrial neoplasms. Short-term data with the use of raloxifene suggest that bone is preserved and lipid profiles are less atherogenic. Long-term studies are needed to determine whether raloxifene or other selective estrogen receptor modulators are associated with any decrease in the risk of breast or endometrial cancer.
Collapse
Affiliation(s)
- C P Spencer
- Department of Obstetrics and Gynaecology, St Thomas' Hospital, London, United Kingdom
| | | | | |
Collapse
|
15
|
Oberhoff C, Szymeczek J, Hoffmann O, Winkler UH, Kaiser S, Schindler AE. Adjuvant antiestrogen treatment with tamoxifen in postmenopausal women with breast cancer: a longitudinal study of blood coagulation and fibrinolysis. Breast Cancer Res Treat 1998; 50:73-81. [PMID: 9802622 DOI: 10.1023/a:1006054309066] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Potential effects of tamoxifen therapy on blood coagulation and fibrinolysis were investigated in women with breast cancer. We studied 14 parameters of hemostasis in 19 postmenopausal women receiving 20 mg tamoxifen/day as an adjuvant treatment. Blood sampling was done before and after the 1st, 3rd, and 6th month of treatment. Pretreatment values of procoagulation, anticoagulation, plasminogen, and plasminogen activator inhibitor were found within the reference range, whereas tissue-plasminogen activator, fibrin degradation products, and prothrombin-fragment 1+2 were elevated. On therapy an initial decrease of all measured parameters was observed. The effect was pronounced in coagulation inhibitors (antithrombin III, protein C and S). No pathological values (below 60%) were observed. No further effects were found during the 3rd and 6th month of treatment. Our data indicate that the decrease of hemostatic parameters during the initial phase of tamoxifen treatment is due to the timing of blood collection, which took place no more than 14 days after surgery. The reduction of coagulation inhibitors was not associated with pathological values. No cumulative effects were seen during tamoxifen therapy. The decrease was not associated with a concomittant increase of in vivo coagulation markers (prothrombin-fragment 1+2, thrombin-antithrombin-complex, fibrin degradation products). Therefore our results are likely to reflect only the resolution of postoperative activation and do not translate into a drug related thrombogenic effect.
Collapse
Affiliation(s)
- C Oberhoff
- Center of Gynecology and Obstetrics, University Hospital Essen, Germany.
| | | | | | | | | | | |
Collapse
|
16
|
Hirvikoski PP, Kumpulainen EJ, Johansson RT. Hepatic toxicity caused by adjuvant CMF/CNF in breast cancer patients and reversal by tamoxifen. Breast Cancer Res Treat 1997; 44:269-74. [PMID: 9266107 DOI: 10.1023/a:1005761302184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of the study was to determine the effect of adjuvant chemotherapy on liver enzymes in breast cancer patients. Furthermore, the effect of tamoxifen on liver enzymes was analyzed. Liver function tests from 194 breast cancer patients who received adjuvant chemotherapy with or without tamoxifen (TAM) were reviewed. Statistically very significant increases were seen in alkaline phosphatase, aspartate acetyl transferase, and gamma glutamyl transferase levels in these patients receiving adjuvant chemotherapy. No statistical changes were noticed in bilirubin levels. If tamoxifen was given together with adjuvant chemotherapy, no changes in liver function tests were detected. Hepatic toxicity was induced in breast cancer patients by adjuvant CMF/CNF therapy (cyclophosphamide, methotrexate, 5-fluorouracil, mitoxantrone). These changes were mostly mild. Adjuvant tamoxifen reduced the increase in liver enzymes caused by adjuvant chemotherapy.
Collapse
Affiliation(s)
- P P Hirvikoski
- Department of Oncology, Kuopio University Hospital, Finland.
| | | | | |
Collapse
|
17
|
Dearing CJ, Harrison SF. Tamoxifen-Induced Hypertriglyceridemia. J Pharm Pract 1997. [DOI: 10.1177/089719009701000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Curt J. Dearing
- 1Address reprint requests to Curt J Dearing, Pharm.D. or Steven F. Harrison Pharm D , Grady Health System, 80 Butler Street, P.O. Box 26041, Atlanta, Georgia 30335-3801
| | - Steven F. Harrison
- 1Address reprint requests to Curt J Dearing, Pharm.D. or Steven F. Harrison Pharm D , Grady Health System, 80 Butler Street, P.O. Box 26041, Atlanta, Georgia 30335-3801
| |
Collapse
|
18
|
Reckless J, Metcalfe JC, Grainger DJ. Tamoxifen decreases cholesterol sevenfold and abolishes lipid lesion development in apolipoprotein E knockout mice. Circulation 1997; 95:1542-8. [PMID: 9118523 DOI: 10.1161/01.cir.95.6.1542] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Apolipoprotein E (apo E) knockout mice develop severe vascular lipid lesions resembling human atherosclerotic plaques, irrespective of the fat content of their diet. METHODS AND RESULTS Oral tamoxifen (TMX) at a dose of 1.9 mg.kg body wt-1.d-1 abolished lipid lesion development, assayed by oil red O staining, whether the mice were fed a normal diet or a diet with high fat content. The TMX-treated mice showed a sevenfold decrease in total cholesterol. However, the proportion of plasma cholesterol present in VLDL remained unchanged, whereas the proportion in LDL decreased by 37%, and that in HDL increased by 64%. Consistent with the shift from LDL to HDL cholesterol, there was a 62% decrease in total triglycerides. The concentrations of active and acid-activatable latent plus active TGF-beta in the aorta were substantially elevated by TMX (87% and 24% increase, respectively). CONCLUSIONS Although the mechanism of cardiovascular protection by TMX in apo E knockout mice is unknown, the inhibition of lipid lesion formation may be attributable to the changes in lipoprotein profile and the elevated levels of TGF-beta, both of which are thought to be protective against atherosclerosis in humans and animal models.
Collapse
Affiliation(s)
- J Reckless
- Department of Biochemistry, University of Cambridge, UK.
| | | | | |
Collapse
|
19
|
Manning JM, Campos G, Edwards IJ, Wagner WD, Wagner JD, Adams MR, Parks JS. Effects of hormone replacement modalities on low density lipoprotein composition and distribution in ovariectomized cynomolgus monkeys. Atherosclerosis 1996; 121:217-29. [PMID: 9125296 DOI: 10.1016/0021-9150(95)05723-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was designed to determine the effect of several hormone replacement therapies on LDL size, density, heterogeneity, and composition in surgically postmenopausal cynomolgus monkeys fed an atherogenic diet. Groups (n = 5 each) of ovariectomized cynomolgus monkeys were untreated (control), or treated with conjugated equine estrogens, medroxyprogesterone acetate (progesterone), combined estrogen-progesterone, or tamoxifen for 9 weeks. There were no differences among treatment groups in total plasma, LDL, or HDL cholesterol or triglyceride concentrations. Plasma LDL were isolated by ultracentrifugation and size exclusion chromatography and subfractionated by density gradient centrifugation for subsequent chemical analysis. Estrogen treatment was associated with significantly smaller (measured as LDL molecular weight, 3.9 +/- 0.2 g/mu mol) and denser plasma LDL (1.034 g/ml peak density) compared with control (4.5 +/- 0.1 g/mu mol; 1.030 g/ml peak density) or progesterone-treated animals (4.6 +/- 0.2; 1.029 g/ml peak density). LDL from the estrogen group were relatively enriched in protein and triglyceride and poor in cholesteryl ester and apolipoprotein F (apoE) compared to the control group. Triglyceride enrichment with estrogen treatment occurred predominantly in the lighter, larger LDL subfractions (d = 1.015-1.025 g/ml), which were reduced in concentration (26 +/- 10 mg cholesterol/dl) compared to control (61 +/- 19 mg/dl) or progesterone treated animals (67 +/- 16 mg/dl). Combined estrogen-progesterone or tamoxifen treatment resulted in changes in LDL that followed the same trend as those observed with estrogen treatment. We conclude that short-term estrogen treatment of ovariectomized cynomolgus monkeys results in changes in plasma LDL size, density, and composition while having no apparent effect on overall plasma lipid concentrations.
Collapse
Affiliation(s)
- J M Manning
- Department of Comparative Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Endocrine treatment plays an important role in the therapy of breast cancer. While the basic mechanisms are understood, additional mechanisms may be of importance to their action and they may also contribute to the mechanism(s) of acquired resistance. Currently, several novel drugs are entering into clinical trials. Observations of the absence or presence of cross resistance to novel 'pure' steroidal antiestrogens and the non-steroidal tamoxifen may add important information to our understanding of the mechanisms of action of both classes of drugs. Similarly, exploration of different aromatase inhibitors in sequence or concert, as well as the combining of different endocrine treatment options may be warranted. Additionally, alterations in different biochemical parameters such as growth factors should not only be carefully explored in relation to treatment options but should also be followed during the course of treatment to asess alterations over time and in relation to the development of drug resistance.
Collapse
MESH Headings
- Adrenal Cortex/drug effects
- Adrenal Cortex/physiopathology
- Adult
- Aged
- Animals
- Antineoplastic Agents, Hormonal/classification
- Antineoplastic Agents, Hormonal/pharmacology
- Antineoplastic Agents, Hormonal/therapeutic use
- Aromatase Inhibitors
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/physiopathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Drug Resistance, Multiple
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Estrogen Antagonists/adverse effects
- Estrogen Antagonists/pharmacology
- Estrogen Antagonists/therapeutic use
- Estrogens/blood
- Estrogens/physiology
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Gonadotropin-Releasing Hormone/agonists
- Humans
- Insulin-Like Growth Factor I/antagonists & inhibitors
- Insulin-Like Growth Factor I/physiology
- Mammary Neoplasms, Experimental/drug therapy
- Mammary Neoplasms, Experimental/physiopathology
- Menopause
- Mice
- Middle Aged
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/genetics
- Neoplasms, Hormone-Dependent/physiopathology
- Neoplasms, Hormone-Dependent/therapy
- Progesterone/antagonists & inhibitors
- Progesterone/physiology
- Progestins/antagonists & inhibitors
- Progestins/pharmacology
- Progestins/therapeutic use
- Receptors, Estrogen/drug effects
- Receptors, Estrogen/physiology
- Signal Transduction/drug effects
- Steroids/metabolism
- Tamoxifen/adverse effects
- Tamoxifen/pharmacology
- Tamoxifen/therapeutic use
- Tumor Cells, Cultured/drug effects
Collapse
Affiliation(s)
- E Lønning
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | | |
Collapse
|
21
|
Grainger DJ, Witchell CM, Metcalfe JC. Tamoxifen elevates transforming growth factor-beta and suppresses diet-induced formation of lipid lesions in mouse aorta. Nat Med 1995; 1:1067-73. [PMID: 7489365 DOI: 10.1038/nm1095-1067] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
When C57B16 male mice are fed a high-fat diet, they develop significant fatty streak lesions in the aorta. Addition of tamoxifen (TMX) to a high-fat diet, equivalent to a dose of approximately 1 mg TMX per kg body weight per day, suppressed the diet-induced increase in the area of lipid staining in the aortic sinus of the mice by 88% and in the average number of lesions by 86%. The TMX-treated mice had 11% +/- 5% less total plasma cholesterol, with most of the reduction in the high density lipoprotein fraction, whereas plasma triglycerides were significantly elevated, and circulating concentrations of 17 beta-estradiol and testosterone were unaffected. Both circulating and aortic concentrations of active and latent transforming growth factor-beta (TGF-beta) were substantially elevated by TMX. The inhibition of lesion formation may be due, at least in part, to cardiovascular protection by TGF-beta.
Collapse
Affiliation(s)
- D J Grainger
- Department of Biochemistry, University of Cambridge, UK
| | | | | |
Collapse
|
22
|
|
23
|
Anker G, Lønning PE, Ueland PM, Refsum H, Lien EA. Plasma levels of the atherogenic amino acid homocysteine in post-menopausal women with breast cancer treated with tamoxifen. Int J Cancer 1995; 60:365-8. [PMID: 7829246 DOI: 10.1002/ijc.2910600316] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Long-term treatment of breast-cancer patients with the anti-oestrogen tamoxifen has been found to be associated with reduced cardiovascular mortality. Plasma homocysteine is an independent risk factor for atherosclerotic disease, and its level is determined by folate and cobalamin status, and possibly also by oestrogen status. We measured the effect of tamoxifen on plasma homocysteine, serum cholesterol, serum cobalamin and serum and erythrocyte folate in 31 post-menopausal women with breast cancer. The plasma homocysteine level was decreased by a mean value of 29.8% after 9-12 months and by 24.5% after 13-18 months of treatment. Tamoxifen suppressed serum cholesterol by mean values varying between 7.2% and 17.6% after 3 to 19 months of treatment. There was no correlation between changes in plasma homocysteine and serum cholesterol. These findings suggest that the homocysteine-lowering effect of tamoxifen may contribute to the reduction of cardiovascular mortality observed in patients on adjuvant therapy with tamoxifen.
Collapse
Affiliation(s)
- G Anker
- Department of Oncology, University Hospital of Bergen, Norway
| | | | | | | | | |
Collapse
|
24
|
Miller ME, Dores GM, Thorpe SL, Akerley WL. Paradoxical influence of estrogenic hormones on platelet-endothelial cell interactions. Thromb Res 1994; 74:577-94. [PMID: 8091401 DOI: 10.1016/0049-3848(94)90215-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Controversies abound in the literature about the safety and efficacy of tamoxifen and estrogen. We studied the effect of these 2 hormonal agents on factors involved in in vitro thrombogenesis: platelets and endothelial cells. Endothelial cells were derived from human umbilical veins and platelets were obtained from premenopausal and postmenopausal women, women on oral contraceptives, postmenopausal women on hormone replacement therapy, men, and patients with breast cancer who had been taking adjuvant tamoxifen for more than 1 year. The interaction of platelets with endothelial cell matrix was measured in 2 systems: 1) in a flow chamber at low shear rate and, 2) with 51Cr labeled platelets in a "static" culture system. In the static system, platelets from women on tamoxifen exhibited decreased platelet adherence to endothelial cell matrix whether they were grown in tamoxifen or control conditions, when compared to platelets from premenopausal women. When flow (25 sec-1) was added these differences were negated. Neither tamoxifen nor 17 beta estradiol had an effect on endothelial cell proliferation or platelet aggregation. Adhesion of platelets at low shear was not altered when platelet rich plasma was incubated with tamoxifen nor when endothelial cells were grown in tamoxifen. In contrast, incubation of platelets in 17 beta estradiol decreased platelet adhesion at low shear rate, however, there was no effect on platelet adhesion when endothelial cells were grown in 17 beta estradiol. We conclude that in early stages of thrombus formation as measured in vitro, tamoxifen may not have a detrimental effect and estrogen may be protective.
Collapse
Affiliation(s)
- M E Miller
- Division of Hematology/Oncology, Memorial Hospital of Rhode Island, Pawtucket 02860
| | | | | | | |
Collapse
|
25
|
Nason FG, Nelson BE. ESTROGEN AND PROGESTERONE IN BREAST AND GYNECOLOGIC CANCERS. Obstet Gynecol Clin North Am 1994. [DOI: 10.1016/s0889-8545(21)00628-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
van den Koedijk CD, Blankenstein MA, Thijssen JH. Speculation on the mechanism of action of triphenylethylene antioestrogens. Biochem Pharmacol 1994; 47:1927-37. [PMID: 8010979 DOI: 10.1016/0006-2952(94)90066-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
27
|
Pérez-López FR, Blasco Comenge C. Effects of tamoxifen on endometrial estrogen and progesterone receptor concentrations in women with fibrocystic disease of the breast. Gynecol Endocrinol 1993; 7:185-9. [PMID: 8291456 DOI: 10.3109/09513599309152501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Endocrine changes were determined after a 3-week cycle of tamoxifen treatment in 11 regularly cycling women with clinical and radiological evidence of fibrocystic disease of the breast. Blood and endometrial samples were obtained during the luteal phase prior to and at the end of treatment. Tamoxifen treatment (20 mg/day orally for 3 weeks), produced a significant increase in plasma estradiol (p = 0.0018) without simultaneous changes in plasma luteinizing hormone, follicle stimulating hormone, prolactin or progesterone. Tamoxifen treatment significantly reduced endometrial estrogen receptor levels compared to the control cycle (p = 0.0018) while endometrial progesterone receptor levels remained unchanged. Endometrial histological studies showed secretory transformation in both the control cycle and after tamoxifen treatment. The reduction in endometrial estrogen receptor concentrations would suggest a tamoxifen-induced effect or a down-regulatory mechanism to protect target tissues from high estradiol levels. These changes were not associated with alterations in either plasma progesterone or endometrial progesterone receptor concentrations. The tamoxifen-induced changes did not produce any interference in the glandular secretory response of the endometrium.
Collapse
Affiliation(s)
- F R Pérez-López
- Department of Obstetrics and Gynecology, Hospital Clínico, Zaragoza, Spain
| | | |
Collapse
|
28
|
Cuzick J, Allen D, Baum M, Barrett J, Clark G, Kakkar V, Melissari E, Moniz C, Moore J, Parsons V. Long term effects of tamoxifen. Biological effects of Tamoxifen Working Party. Eur J Cancer 1993; 29A:15-21. [PMID: 1445735 DOI: 10.1016/0959-8049(93)90568-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A total of 153 breast cancer patients who participated in two trials of adjuvant tamoxifen and who had not recurred were recruited into a study of the long term effects of tamoxifen. There were 60 controls (no tamoxifen), 73 ex-users (mostly for 2 years) and 20 current users (median treatment duration 72 months) and the median follow-up time was 7 years. A wide ranging study of lipids, hormones, bone density and haemostasis was undertaken. When compared with controls, current users had lower cholesterol levels (especially low density cholesterol), and increased triglyceride levels. Thyroid hormones were higher and sex hormone binding globulin was almost doubled. Bone density was non-significantly higher, clotting times were slightly shorter and fibrinogen and antithrombin III levels were reduced. However few of these changes persisted in ex-users, suggesting that most of the biological effects of treatment are reversible on cessation of treatment. This is reassuring for potentially negative side-effects, but also indicates that potentially positive 'side-effects' such as cholesterol lowering only occur while on active treatment.
Collapse
Affiliation(s)
- J Cuzick
- Imperial Cancer Research Fund, Lincoln's Inn Fields, London, U.K
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- I S Fentiman
- Department of Clinical Oncology, Guy's Hospital, London, UK
| | | |
Collapse
|
30
|
Abstract
Tamoxifen is a nonsteroidal antiestrogen that has found successful applications for each stage of breast cancer in the treatment of selected patients. Tamoxifen was originally introduced for the treatment of advanced disease in postmenopausal women; however, the drug is now also available for the palliative treatment of premenopausal women with estrogen receptor (ER) positive disease. The proven efficacy of tamoxifen and the low incidence of side effects made the drug an ideal agent to test as an adjuvant therapy for women with node-positive breast cancer. Laboratory studies indicate that long-term treatment schedules may provide maximal benefit in preventing recurrence, and recent analysis of clinical trials demonstrates that between 2 and 5 years of adjuvant tamoxifen therapy provides a survival advantage for postmenopausal women with node-positive disease. Similarly, adjuvant studies in node-negative breast cancer have demonstrated an increase in the disease-free survival of both pre- and postmenopausal patients with ER-positive tumors. However, the extended use of tamoxifen has raised questions about the long-term safety of antiestrogen therapy. Of special concern is the impact of tamoxifen on ovarian function in premenopausal women and the potential risks to the fetus if pregnancy occurs. Fortunately, there are no reports about the teratogenicity of tamoxifen in the human, but it is important that physicians counsel women about the risk of pregnancy. Tamoxifen should not be used if a patient is pregnant. Initial concerns that the long-term administration of an antiestrogen would increase bone loss and increase the risks of coronary heart disease appear to be unwarranted. Tamoxifen has some estrogen-like activities in postmenopausal women and causes a preservation of bone in the lumbar spine and a decrease in circulating cholesterol. Indeed, a reduction in fatal myocardial infarction (MI) has been noted during 5 years of tamoxifen therapy, possibly the direct result of a prolonged reduction in circulating cholesterol. However, the estrogen-like qualities of tamoxifen that could be valuable as a hormone replacement therapy for all postmenopausal women following a diagnosis of breast cancer may also increase the risk for developing endometrial carcinoma. To date, there are only a few reports of endometrial carcinoma being diagnosed during adjuvant therapy with tamoxifen; however, any instances of uterine bleeding or spotting should be followed up with an endometrial biopsy. There are some concerns about large doses of tamoxifen promoting liver cancer in rats. These results are of particular concern if tamoxifen is to be used as a preventive in normal women.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- V C Jordan
- Department of Human Oncology, University of Wisconsin, Comprehensive Cancer Center, Madison
| |
Collapse
|
31
|
McDonald CC, Stewart HJ. Fatal myocardial infarction in the Scottish adjuvant tamoxifen trial. The Scottish Breast Cancer Committee. BMJ (CLINICAL RESEARCH ED.) 1991; 303:435-7. [PMID: 1912833 PMCID: PMC1670561 DOI: 10.1136/bmj.303.6800.435] [Citation(s) in RCA: 275] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the incidence of fatal myocardial infarction in women in the two randomised arms of the Scottish adjuvant tamoxifen trial. DESIGN Retrospective review of hospital notes to determine with the greatest possible certainty women who had died of an acute myocardial infarction. SETTING Scottish Cancer Trials Office, the University of Edinburgh. PATIENTS 1070 postmenopausal women with operable breast cancer who were randomised to receive either adjuvant tamoxifen for five years or until relapse (539 patients) or tamoxifen for at least six weeks on the confirmation of first recurrence (531 patients). MAIN OUTCOME MEASURES Incidence of fatal myocardial infarction in women with no known or suspected systemic cancer. RESULTS Of the 200 women who died in the adjuvant tamoxifen arm of the trial, 44 were free of cancer at death and 10 of these died of myocardial infarction. In the observation arm 251 women died, of whom 61 showed no evidence of systemic cancer and 25 had a fatal myocardial infarction. The incidence of fatal myocardial infarction in the two groups was significantly different (chi 2 = 6.88, p = 0.0087). CONCLUSION Tamoxifen given for at least five years as adjuvant therapy for breast cancer seems to have a cardioprotective oestrogen-like effect in postmenopausal women.
Collapse
Affiliation(s)
- C C McDonald
- Scottish Cancer Trials Office (Medical Research Council), Medical School, Edinburgh
| | | |
Collapse
|
32
|
|
33
|
Abstract
The serum cholesterol levels of 123 consecutively and newly diagnosed women with Stage I and II breast cancer taking tamoxifen were compared with a control group of 81 consecutively newly diagnosed women with Stage I and II breast cancer who were not taking a hormonal treatment or supplement. Other factors that were evaluated were age, menopausal status, tumor size, weight, height, Quetelet index, and smoking and alcohol intake history. The mean cholesterol change in patients on tamoxifen (34.2 +/- 3.6 mg/dl) was significantly greater than controls (1.0 +/- 4.1 mg/dl) (P less than 0.001). Serum cholesterol fell by more than 10 mg/dl in 72.9% of women on tamoxifen vs. 35.1% of controls and by more than 40 mg/dl in 39.9% of women on tamoxifen vs. 12.6% of controls. Multivariate analysis revealed that tamoxifen administration (P less than 0.0001), initial cholesterol level (P = 0.001), and age (P = 0.04) were significant factors in producing a decrease in serum cholesterol. The administration of tamoxifen as adjuvant therapy to women with newly diagnosed breast cancer resulted in a significant fall in serum cholesterol. This effect of tamoxifen on the serum cholesterol may prove to be an additional benefit in the form of reduced cardiovascular risk in these women.
Collapse
Affiliation(s)
- D V Schapira
- Section of Cancer Prevention, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612
| | | | | |
Collapse
|
34
|
Fentiman IS, Caleffi M, Rodin A, Murby B, Fogelman I. Bone mineral content of women receiving tamoxifen for mastalgia. Br J Cancer 1989; 60:262-4. [PMID: 2765377 PMCID: PMC2247046 DOI: 10.1038/bjc.1989.266] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Dual photon absorptiometry (DPA) has been used to measure the effect of short and medium-term administration of tamoxifen on bone density in the axial skeleton of women with mastalgia. This provided a unique opportunity to monitor the effect of this 'anti-oestrogenic' agent in predominantly premenopausal women, not suffering from malignancy. In addition, plasma levels of calcium, phosphate, alkaline phosphatase and serum levels of oesteocalcin (GLA) have been assayed, both before and after 3 months of starting either tamoxifen or placebo treatment. No significant alterations in bone density were seen. Osteocalcin, alkaline phosphatase and electrolytes were unchanged and there was no dose response observed in women receiving either 10 mg or 20 mg of tamoxifen. Although possessing anti-oestrogenic properties, tamoxifen is also a partial agonist. Administration for the short periods does not measurably influence spinal or femoral bone density and thus the agent can probably be given safely for the short-term treatment of mastalgia.
Collapse
Affiliation(s)
- I S Fentiman
- Department of Clinical Oncology, Guy's Hospital, London, UK
| | | | | | | | | |
Collapse
|
35
|
Affiliation(s)
- I S Fentiman
- ICRF Clinical Oncology Unit, Guy's Hospital, London, UK
| |
Collapse
|