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Van Houdt M, Han SN, Pauwels S, Billen J, Neven P. Measurable Serum Estradiol and Estrone in Women 36-56 Years During Adjuvant Treatment With Aromatase Inhibitors for a Hormone Receptor-Positive Breast Cancer. Case Studies and Cross-sectional Study Using an Ultra-sensitive LC-MS/MS-Method. Clin Breast Cancer 2023; 23:84-90. [PMID: 36376236 DOI: 10.1016/j.clbc.2022.09.007] [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: 11/21/2021] [Revised: 03/30/2022] [Accepted: 09/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Ovarian function recovery (OFR) during adjuvant use of an aromatase inhibitor (AI) negatively impacts breast cancer outcome. We measured serum FSH and estrogen levels in consecutive AI-users with an uncertain menopausal status during follow-up and report associated risk factors of OFR METHODS: A retrospective cross sectional observational monocentric study including breast cancer patients in follow-up using an adjuvant AI, age 36 to 56 years, with at least one serum estradiol (E2) and estrone (E1) measurement between 2013 and 2020. Estrogens were quantified using a sensitive liquid chromatography-tandem mass spectrometry method (LC-MS/MS). Women on LHRH agonist were included while those with a bilateral oophorectomy or ovarian irradiation were not. We aimed to identify risk factors of OFR considering age, body mass index (BMI), previous chemotherapy and duration of AI use. Univariable analysis was used to evaluate risk factors of OFR. RESULTS E2/E1 levels were assessed in 207 patients with a median age of 50 years (range 36-56). 17 of 159 on AI (10.7%) and 3 of 48 on AI + LHRH (6.3%) had OFR. Seven out of 17 patients (41,2%) with OFR in the AI only group and 2 out of 3 patients (66,7%) in the AI+LHRH agonist group were in amenorrhea. Age <50 y and adjuvant chemotherapy were statistically significantly different between the OFR group and the group with postmenopausal estrogen levels. CONCLUSION Breast cancer patients aged 36 to56 years need to be monitored closely during adjuvant treatment with aromatase inhibitors: to confirm menopausal status, to evaluate compliance and to ensure ovarian activity remains adequately suppressed. Estrone might be a better marker then estradiol to detect ovarian reactivation.
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Affiliation(s)
- M Van Houdt
- Gynecology, University Hospitals of Leuven, Leuven.
| | - S N Han
- Gynecology, University Hospitals of Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals of Leuven, Leuven
| | - S Pauwels
- Department of Laboratory Medicine, University Hospitals of Leuven, Leuven
| | - J Billen
- Department of Laboratory Medicine, University Hospitals of Leuven, Leuven
| | - P Neven
- Gynecology, University Hospitals of Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals of Leuven, Leuven
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Leite B, de Bem Fretta T, Boing L, Coutinho de Azevedo Guimarães A. Can belly dance and mat Pilates be effective for range of motion, self-esteem, and depressive symptoms of breast cancer women? Complement Ther Clin Pract 2021; 45:101483. [PMID: 34517217 DOI: 10.1016/j.ctcp.2021.101483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to analyse the effect of an intervention with belly dance or mat Pilates on range of motion, self-esteem and depressive symptoms in women with breast cancer receiving hormone therapy. METHOD A randomized clinical trial of 52 participants, diagnosed with breast cancer and undergoing adjuvant hormone therapy that were randomized and divided into three groups (1): Belly dance group, which received 16 weeks of Belly Dance classes 2) Mat Pilates group, that performed 16 weeks of Pilates intervention and (3) Control group, that received educational activities in the form of lectures and was invited to maintain its routine activities. The participants answered a questionnaire in which they contained the clinical and personal characteristics; quantification of the range of motion of the upper limbs using the Absolute Axis 360° digital goniometer; self-esteem by the Self-Esteem Scale (EAR) and depressive symptoms by the Beck Depression Inventory (BDI). All data was collected at two moments in the study, in the pre-intervention period (baseline) and at the end of the 16 weeks of intervention. RESULTS Only the variable range of motion variable showed significant results in all study groups (p = 0.025), with the Mat Pilates group having the best scores. Although not significant, the other study variables also improved after the intervention period. CONCLUSION Belly dance and the Mat Pilates can bring positive results in the range of movement of women undergoing adjuvant treatment of breast cancer, with the Pilates method being the one that most contributed to improvements in this variable.
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Affiliation(s)
- Bruna Leite
- Physiotherapy, Science Center of Health Sciences and Sports, Santa Catarina State University, Brazil.
| | - Tatiana de Bem Fretta
- Functional Performance Physiotherapist, Ribeirão Preto Medical School- University of São Paulo, Brazil
| | - Leonessa Boing
- Human Movement, Science Center of Health Sciences and Sports, Santa Catarina State University, Scholarship of the Coordination of Improvement of Higher Level (CAPES), Brazil
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Shenouda M, Copley R, Pacioles T, Lebowicz Y, Jamil M, Akpanudo S, Tirona MT. Effect of Tart Cherry on Aromatase Inhibitor-Induced Arthralgia (AIA) in Nonmetastatic Hormone-Positive Breast Cancer Patients: A Randomized Double-Blind Placebo-Controlled Trial. Clin Breast Cancer 2021; 22:e30-e36. [PMID: 34275765 DOI: 10.1016/j.clbc.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aromatase Inhibitor induced Arthralgia (AIA) can cause noncompliance leading to decreased breast-cancer survival. Effective interventions for AIA are limited. Tart cherry (TC) showed beneficial effect on musculoskeletal pain. 48 patients (Pts) randomized to TC versus placebo over 6 weeks, TC (23pts) had 34.7% mean pain decrease versus 1.4% in Placebo (25pts). TC can improve AIA in nonmetastatic breast-cancer patients. METHODS Randomized, placebo-controlled, double-blind trial. Eligible patients with NMHPBC on AI for at least 4 weeks were randomized to TC concentrate [50 tart cherries] vs. placebo (P) [syrup] in 1:1 model. Patients instructed to consume 1 Oz of concentrate in 8 Oz water daily for 6 weeks, and document their pain intensity at baseline, weekly and at study completion in a diary using Visual Analog Scale (VAS), with 0 mm indicating no pain, and 100 mm indicating highest pain. RESULTS Sixty patients were enrolled. Two patients did not complete the study due to diarrhea, and 10 patients were noncompliant. Forty-eight patients were included in the final analysis. TC group (23 pts) had 34.7% mean decrease in pain compared to 1.4% in P group (25 pts). This difference was statistically significant (Mann-Whitney U Test, P = .034). CONCLUSIONS Tart cherry can significantly improve AIA in nonmetastatic breast cancer patient.
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Affiliation(s)
- Mina Shenouda
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV.
| | - Renee Copley
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Toni Pacioles
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Yehuda Lebowicz
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV; Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | - Muhammad Jamil
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
| | - Sutoidem Akpanudo
- Internal Medicine Department, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV; Internal Medicine Department, Duke University, Durham, NC
| | - Maria Tria Tirona
- Hematology Oncology Department, Marshall University, Joan C. Edwards School of Medicine, Edwards Comprehensive Cancer Center, Huntington, WV
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4
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Mirfakhraee S, Chan AVC, Ganji N, Abramowitz J. Dual treatment of acromegaly and hormone-receptor-positive breast cancer with tamoxifen: a case report. J Med Case Rep 2021; 15:207. [PMID: 33910628 PMCID: PMC8082960 DOI: 10.1186/s13256-021-02792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adjuvant endocrine therapy is recommended for the treatment of hormone-receptor-positive breast cancer. Aromatase inhibitors are associated with significant musculoskeletal adverse effects, likely through growth hormone/insulin-like growth factor 1 modulation, while tamoxifen reduces insulin-like growth factor 1 production. We describe the case of a patient who was treated successfully with tamoxifen for her hormone-receptor-positive breast cancer and acromegaly. Case presentation A 57-year old White female with hormone-receptor-positive breast cancer was diagnosed with acromegaly. She received adjuvant endocrine therapy with anastrozole but could not tolerate this medication because of severe arthralgia, so she was switched to tamoxifen. Shortly after starting tamoxifen, the patient’s musculoskeletal symptoms resolved and her insulin-like growth factor 1 levels normalized. She has remained in remission of her acromegaly and breast cancer since initiating tamoxifen. Conclusion This case highlights the dual benefit of tamoxifen therapy in the treatment of hormone-receptor-positive breast cancer and acromegaly. Unlike anastrozole, tamoxifen has the benefit of lowering insulin-like growth factor 1 levels, which underscores its advantage in reducing adverse musculoskeletal symptoms during the treatment of hormone-receptor-positive breast cancer. We offer the first reported use of tamoxifen monotherapy for the successful treatment of acromegaly and hormone-receptor-positive breast cancer. While tamoxifen may offer an additional, oral option for acromegaly patients who do not respond to or tolerate conventional growth-hormone-lowering therapy, additional studies are necessary.
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Affiliation(s)
- Sasan Mirfakhraee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,UT Southwestern Medical Center, WCB3 8th Floor, 2001 Inwood Rd, Dallas, TX, 75390, USA.
| | - Alberto V Cabo Chan
- Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Niloofar Ganji
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Jessica Abramowitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kauffman RP, Young C, Castracane VD. Perils of prolonged ovarian suppression and hypoestrogenism in the treatment of breast cancer: Is the risk of treatment worse than the risk of recurrence? Mol Cell Endocrinol 2021; 525:111181. [PMID: 33529690 DOI: 10.1016/j.mce.2021.111181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA.
| | - Christina Young
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
| | - V Daniel Castracane
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
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Bennedsgaard K, Ventzel L, Themistocleous AC, Bennett DL, Jensen AB, Jensen AR, Andersen NT, Jensen TS, Tankisi H, Finnerup NB. Long-term symptoms of polyneuropathy in breast and colorectal cancer patients treated with and without adjuvant chemotherapy. Cancer Med 2020; 9:5114-5123. [PMID: 32469145 PMCID: PMC7367625 DOI: 10.1002/cam4.3129] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to assess chemotherapy‐induced polyneuropathy (CIPN) 5 years after adjuvant chemotherapy in patients with breast and colorectal cancer. The association of CIPN with quality of life, anxiety, and depression was analyzed. Methods Of a set of 100 patients with breast cancer and of 74 with colorectal cancer who had undergone surgery and adjuvant chemotherapy in 2011‐2012, 80 and 52 patients alive, respectively, were included together with two reference groups of 249 breast cancer patients and 83 colorectal cancer patients who had undergone surgery only. All patients were sent a questionnaire on alcohol consumption, smoking habits, comorbidity, medicine consumption, and oxaliplatin‐specific questions, as well as the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), the Douleur Neuropathique 4 Questions (DN4q), the EQ‐5D, and the Hospital Anxiety and Depression Scale. Possible polyneuropathy was defined as the presence of numbness and/or tingling in the feet, secondly as a score of ≥4 on the MNSIq. Possible painful polyneuropathy was defined as pain in both feet and a score ≥3 on the DN4q. Results The prevalence of possible polyneuropathy defined by numbness and/or tingling in the feet was 38.8% (28.1‐50.3) after adjuvant docetaxel and 57.7% (43.2‐71.3) after adjuvant oxaliplatin, with no significant difference from a previous 1‐year follow‐up (P >.35). Fewer had possible polyneuropathy as defined by the MNSIq. Patients with possible polyneuropathy after adjuvant chemotherapy reported significantly lower quality of life than patients treated with surgery only. Conclusion Symptoms of polyneuropathy following adjuvant docetaxel and oxaliplatin persist 5 years after treatment and affect quality of life negatively.
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Affiliation(s)
- Kristine Bennedsgaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas C Themistocleous
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anni R Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Zhu Y, Cohen SM, Rosenzweig MQ, Bender CM. Symptom Map of Endocrine Therapy for Breast Cancer: A Scoping Review. Cancer Nurs 2020; 42:E19-E30. [PMID: 30138143 PMCID: PMC6935534 DOI: 10.1097/ncc.0000000000000632] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple symptoms associated with endocrine therapy have a detrimental impact on medication adherence and quality of life. OBJECTIVE The purpose of this scoping review is to map the symptoms during endocrine therapy for breast cancer to provide implications for current practice and suggestions for future research. METHODS The PubMed, CINAHL, and China Science Periodical Databases were searched to identify related studies published in English and Chinese languages. References of included articles were reviewed for additional eligible studies. Of the 2551 articles identified, 57 articles met inclusion criteria and were included in this scoping review. RESULTS Evidence for the 16 most studied symptoms and 15 most prevalent symptoms were synthesized. Five key symptoms associated with endocrine therapy were identified, including joint/muscle pain, hot flashes, low sexual interest/desire, joint/muscle stiffness, and fatigue/lack of energy. Rarely studied but highly prevalent symptoms and other gaps in the symptom science during endocrine therapy for breast cancer were identified. CONCLUSION Nurses caring for women receiving endocrine therapy for breast cancer should assess the 5 key symptoms identified. There remain substantial gaps in the science related to the symptom experience during endocrine therapy for breast cancer. Future studies should focus on the domains of symptom intensity and distress, specific understudied symptoms, symptom clusters, and development of symptom assessment instruments specific to symptoms associated with endocrine therapy. IMPLICATIONS FOR PRACTICE This scoping review identified 5 well-studied and highly prevalent symptoms that should be assessed in women with breast cancer receiving endocrine therapy.
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Affiliation(s)
- Yehui Zhu
- Author Affiliations: School of Nursing, University of Pittsburgh, Pennsylvania
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Nabieva N, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Hack CC, Almstedt K, Gass P, Heindl F, Brodkorb T, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA. Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients. Int J Cancer 2019; 145:2114-2121. [PMID: 30901076 DOI: 10.1002/ijc.32294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/16/2018] [Accepted: 01/10/2019] [Indexed: 01/14/2023]
Abstract
One of the most common adverse events (AEs) occurring during treatment with aromatase inhibitors (AIs) is musculoskeletal pain. The aim of our study was to analyze the influence of preexisting muscle/limb pain and joint pain on the development of AI-induced musculoskeletal AEs. Women eligible for upfront adjuvant endocrine therapy with letrozole were included in the PreFace study, a multicenter phase IV trial. During the first treatment year, they were asked to record musculoskeletal AEs monthly by answering questions regarding pain symptoms and rating the pain intensity on a numeric rating scale from 0 (no pain) to 10 (very strong pain). Pain values were compared using nonparametric statistical tests. Overall, 1,416 patients were evaluable. The average pain value over all time points in women with preexisting muscle/limb pain was 4.3 (median 4.3); in those without preexisting pain, it was 2.0 (median 1.7). In patients without preexisting muscle/limb pain, pain levels increased relatively strongly within the first 6 months (mean increase +0.9, p < 0.00001) in comparison with those with preexisting pain (mean increase +0.3, p < 0.001), resulting in a statistically significant difference (p < 0.00001) between the two groups. The development of joint pain was similar in the two groups. Women without preexisting muscle/limb pain or joint pain have the greatest increase in pain after the start of adjuvant AI therapy. Women with preexisting pain have significantly higher pain values. The main increase in pain values takes place during the first 6 months of treatment.
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Affiliation(s)
- Naiba Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sara Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - Wolfgang Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Bernhard Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,St. Theresien Hospital, Nuremberg, Germany
| | | | | | - Gerold Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - Alexander Fridman
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Oliver Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - Sherko Kuemmel
- Breast Unit, Essen Mitte Clinics, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Heiko Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | | | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Katrin Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tobias Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | | | - Petra Krabisch
- Department of Gynecology, Clinic of Chemnitz gGmbH, Chemnitz, Germany
| | - Michael Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | | | - Andreas Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - Cosima Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | | | | | - Volker Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - Brigitte Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany.,Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - Achim Rody
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Lübeck, Schleswig-Holstein, Germany
| | - Nicolai Maass
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Kiel, Schleswig-Holstein, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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9
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Hertz DL, Speth KA, Kidwell KM, Gersch CL, Desta Z, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. Variable aromatase inhibitor plasma concentrations do not correlate with circulating estrogen concentrations in post-menopausal breast cancer patients. Breast Cancer Res Treat 2017; 165:659-668. [PMID: 28643023 PMCID: PMC5709190 DOI: 10.1007/s10549-017-4346-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE The aromatase inhibitors (AI) exemestane (EXE), letrozole (LET), and anastrozole suppress estrogen biosynthesis, and are effective treatments for estrogen receptor (ER)-positive breast cancer. Prior work suggests that anastrozole blood concentrations are associated with the magnitude of estrogen suppression. The objective of this study was to determine whether the magnitude of estrogen suppression, as determined by plasma estradiol (E2) concentrations, in EXE or LET treated patients is associated with plasma AI concentrations. METHODS Five hundred post-menopausal women with ER-positive breast cancer were enrolled in the prospective Exemestane and Letrozole Pharmacogenetic (ELPh) Study conducted by the COnsortium on BReast cancer phArmacogomics (COBRA) and randomly assigned to either drug. Estrogen concentrations were measured at baseline and after 3 months of AI treatment and drug concentrations were measured after 1 or 3 months. EXE or LET concentrations were compared with 3-month E2 concentration or the change from baseline to 3 months using several complementary statistical procedures. RESULTS Four-hundred patients with on-treatment E2 and AI concentrations were evaluable (EXE n = 200, LET n = 200). Thirty (7.6%) patients (EXE n = 13, LET n = 17) had 3-month E2 concentrations above the lower limit of quantification (LLOQ) (median: 4.75; range: 1.42-63.8 pg/mL). EXE and LET concentrations were not associated with on-treatment E2 concentrations or changes in E2 concentrations from baseline (all p > 0.05). CONCLUSIONS Steady-state plasma AI concentrations do not explain variability in E2 suppression in post-menopausal women receiving EXE or LET therapy, in contrast with prior evidence in anastrozole treated patients.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St. Room 3054, Ann Arbor, MI, 48109-1065, USA.
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA.
| | - Kelly A Speth
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Kelley M Kidwell
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Christina L Gersch
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
| | | | | | | | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, USA
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
| | - N Lynn Henry
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
- Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, UT, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, USA
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Dowling M, McDonagh B, Meade E. Arthralgia in Breast Cancer Survivors: An Integrative Review of Endocrine Therapy. Oncol Nurs Forum 2017. [DOI: 10.1188/17.337-349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hertz DL, Henry NL, Rae JM. Germline genetic predictors of aromatase inhibitor concentrations, estrogen suppression and drug efficacy and toxicity in breast cancer patients. Pharmacogenomics 2017; 18:481-499. [PMID: 28346074 PMCID: PMC6219438 DOI: 10.2217/pgs-2016-0205] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023] Open
Abstract
The third-generation aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, are highly effective for the treatment of estrogen receptor-positive breast cancer in postmenopausal women. AIs inhibit the aromatase (CYP19A1)-mediated production of estrogens. Most patients taking AIs achieve undetectable blood estrogen concentrations resulting in drug efficacy with tolerable side effects. However, some patients have suboptimal outcomes, which may be due, in part, to inherited germline genetic variants. This review summarizes published germline genetic associations with AI treatment outcomes including systemic AI concentrations, estrogenic response to AIs, AI treatment efficacy and AI treatment toxicities. Significant associations are highlighted with commentary about prioritization for future validation to identify pharmacogenetic predictors of AI treatment outcomes that can be used to inform personalized treatment decisions in patients with estrogen receptor-positive breast cancer.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, USA
| | - N Lynn Henry
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84103, USA
| | - James M Rae
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-1065, USA
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Chemotherapy-induced pain and neuropathy: a prospective study in patients treated with adjuvant oxaliplatin or docetaxel. Pain 2016; 157:560-568. [PMID: 26529271 DOI: 10.1097/j.pain.0000000000000404] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer therapy. This study evaluates symptoms of CIPN and CIPN-related pain and its influence on psychological functioning and potential predictors of chronic CIPN and pain. In this large prospective questionnaire study, 174 patients receiving adjuvant oxaliplatin or docetaxel were consecutively included. Patients were asked to complete a questionnaire with validated questions on peripheral neuropathy, pain, anxiety and depression, and quality of life at baseline, after the first cycle, halfway through therapy, and 1 year after baseline. Chronic CIPN symptoms (tingling and/or numbness) in the feet at 1-year follow-up were present in 63.6% of patients without preexisting neuropathy in the oxaliplatin group and in 44.8% in the docetaxel group, whereas pain in hands and feet was found in 31.3% and 35.1%, respectively. Both groups had significantly different pain profiles, and persistent pain in the docetaxel group was found to have effect on psychological function. Cumulative dose predicted oxaliplatin-induced neuropathy (P = 0.004), whereas endocrine therapy predicted peripheral pain in the docetaxel group (P = 0.04). There are important differences in acute neuropathic symptoms and chronic pain profiles in patients after oxaliplatin and docetaxel treatment. It is, however, important to recognize that chronic peripheral pain may be unrelated to neuropathy and can be caused by concomitant treatments. Future studies should focus on characterizing and distinguishing CIPN-related pain from other types of pain to determine the best outcome measures for trials on prevention or relief.
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Lombard JM, Zdenkowski N, Wells K, Beckmore C, Reaby L, Forbes JF, Chirgwin J. Aromatase inhibitor induced musculoskeletal syndrome: a significant problem with limited treatment options. Support Care Cancer 2015; 24:2139-2146. [PMID: 26556210 DOI: 10.1007/s00520-015-3001-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management. METHODS A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used. RESULTS Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category. CONCLUSION We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.
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Affiliation(s)
- Janine M Lombard
- Calvary Mater Newcastle, Newcastle, NSW, Australia. .,University of Newcastle, Newcastle, NSW, Australia. .,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.
| | - Nicholas Zdenkowski
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Kathy Wells
- Breast Cancer Network Australia, Newcastle, Vic, Australia
| | - Corinna Beckmore
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Linda Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - John F Forbes
- Calvary Mater Newcastle, Newcastle, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - Jacquie Chirgwin
- University of Newcastle, Newcastle, NSW, Australia.,Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia.,Monash University, Newcastle, Vic, Australia
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Abstract
INTRODUCTION Aromatase inhibitor (AI) therapy is the current preferred choice of endocrine therapy in postmenopausal estrogen receptor-positive breast cancer patients thanks to their improved effectiveness compared to tamoxifen. Despite the absence of increased endometrial pathology and deep venous thrombosis seen in tamoxifen-users, the safety profile of AIs consists of a variety of bothersome side effects negatively influencing daily functioning. AREAS COVERED Besides the well-known adverse effects on joints and bone and the vasomotor system, more neglected and latent toxicity like cognitive problems and vulvovaginal atrophy will be discussed. Concern has been raised in terms of increased risk of fractures and cardiovascular events with chronic AI use. EXPERT OPINION Placebo-controlled long-term studies carefully monitoring these adverse events, together with more extensive research in the etiologies, are warranted.
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