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Pineda E, Ortega-Vélez MI, Preciado-Rodríguez M, Saucedo-Tamayo S, Caire-Juvera G. Dietary patterns, cooking methods and breast cancer risk in Mexico: An exploratory case-control study. Nutr Health 2024; 30:349-359. [PMID: 35971312 DOI: 10.1177/02601060221119260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nutrition has an important influence on the risk of developing breast cancer (BC). Dietary patterns can capture the complex interplay of nutrients and cooking methods can contribute to the presence of heterocyclic amines, which are potent mammary carcinogens. Research on dietary patterns, cooking methods, and their association with BC in Mexican women is scarce. Aim: To evaluate the association of dietary patterns and cooking methods with BC risk among women from the Northwest region of Mexico. Methods: This case-control study included 120 women. Eligible cases (n = 60) were diagnosed and biopsy-confirmed in the past 2 years. Control subjects (n = 60) were hospital and population-based. Dietary intake and cooking methods were respectively assessed through a food frequency questionnaire (FFQ) and the National Cancer Institute survey. We obtained dietary patterns from a K-means cluster analysis (CA), and multivariate logistic regression tested the association of dietary patterns and cooking methods with BC risk. Results: Prudent and caloric dietary patterns were identified. The caloric pattern was associated with BC risk (Model 1: ORadj: 5.07, 95%CI:1.44-17.84, p = 0.011; Model 2: ORadj: 4.99 (95%CI:1.39-17.92, p = 0.014). Intense frying, meat grilling and poultry resulted in a significant BC risk (Model 1: ORadj: 5.54,95%CI: 2.13-14.41), p < 0.001; Model 2: ORadj: 5.12, 95%CI: 1.83-14.31, p = 0.002). At Oestrogen exposure of <32 years, there was an association between dietary patterns and BC risk (ORadj: 4.69, 95%CI: 1.01-21.92, p = 0.049). The relationship between BC risk and cooking intensity was found in both strata of exposure to oestrogens: <32 years (ORadj: 3.72, 95%CI:1.04-13.33, p = 0.044), and ≥32 years (ORadj: 6.06, 95%CI:1.34-27.42, p = 0.019). Conclusions: A caloric dietary pattern rich in refined carbohydrates and saturated fat, and intense meat product cooking may increase the risk of BC in Mexican women.
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Affiliation(s)
- Elisa Pineda
- Department of Nutrition, Food and Development Research Center [Centro de Investigación en Alimentación y Desarrollo (CIAD) A.C.], Hermosillo, Sonora, México
- School of Public Health, Imperial College London, London, UK
- Centre for Health Economics & Policy Innovation, Imperial College London, London, UK
| | - María I Ortega-Vélez
- Department of Nutrition, Food and Development Research Center [Centro de Investigación en Alimentación y Desarrollo (CIAD) A.C.], Hermosillo, Sonora, México
| | - Martin Preciado-Rodríguez
- Regional Development Department, Food and Development Research Center [Centro de Investigación en Alimentación y Desarrollo (CIAD) A.C.], Hermosillo, Sonora, México
| | - Socorro Saucedo-Tamayo
- Department of Nutrition, Food and Development Research Center [Centro de Investigación en Alimentación y Desarrollo (CIAD) A.C.], Hermosillo, Sonora, México
| | - Graciela Caire-Juvera
- Department of Nutrition, Food and Development Research Center [Centro de Investigación en Alimentación y Desarrollo (CIAD) A.C.], Hermosillo, Sonora, México
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2
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Ntafoulis I, Koolen SLW, Leenstra S, Lamfers MLM. Drug Repurposing, a Fast-Track Approach to Develop Effective Treatments for Glioblastoma. Cancers (Basel) 2022; 14:3705. [PMID: 35954371 PMCID: PMC9367381 DOI: 10.3390/cancers14153705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Glioblastoma (GBM) remains one of the most difficult tumors to treat. The mean overall survival rate of 15 months and the 5-year survival rate of 5% have not significantly changed for almost 2 decades. Despite progress in understanding the pathophysiology of the disease, no new effective treatments to combine with radiation therapy after surgical tumor debulking have become available since the introduction of temozolomide in 1999. One of the main reasons for this is the scarcity of compounds that cross the blood-brain barrier (BBB) and reach the brain tumor tissue in therapeutically effective concentrations. In this review, we focus on the role of the BBB and its importance in developing brain tumor treatments. Moreover, we discuss drug repurposing, a drug discovery approach to identify potential effective candidates with optimal pharmacokinetic profiles for central nervous system (CNS) penetration and that allows rapid implementation in clinical trials. Additionally, we provide an overview of repurposed candidate drug currently being investigated in GBM at the preclinical and clinical levels. Finally, we highlight the importance of phase 0 trials to confirm tumor drug exposure and we discuss emerging drug delivery technologies as an alternative route to maximize therapeutic efficacy of repurposed candidate drug.
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Affiliation(s)
- Ioannis Ntafoulis
- Brain Tumor Center, Department of Neurosurgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (I.N.); (S.L.)
| | - Stijn L. W. Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands
| | - Sieger Leenstra
- Brain Tumor Center, Department of Neurosurgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (I.N.); (S.L.)
| | - Martine L. M. Lamfers
- Brain Tumor Center, Department of Neurosurgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (I.N.); (S.L.)
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3
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Arnone AA, Cline JM, Soto-Pantoja DR, Cook KL. Investigating the role of endogenous estrogens, hormone replacement therapy, and blockade of estrogen receptor-α activity on breast metabolic signaling. Breast Cancer Res Treat 2021; 190:53-67. [PMID: 34448090 PMCID: PMC8557185 DOI: 10.1007/s10549-021-06354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/06/2021] [Indexed: 12/11/2022]
Abstract
Purpose Menopause is associated with an increased risk of estrogen receptor-positive (ER +) breast cancer. To characterize the metabolic shifts associated with reduced estrogen bioavailability on breast tissue, metabolomics was performed from ovary-intact and ovariectomized (OVX) female non-human primates (NHP). The effects of exogenous estrogen administration or estrogen receptor blockade (tamoxifen treatment) on menopause-induced metabolic changes were also investigated. Methods Bilateral ovariectomies were performed on female cynomolgus macaques (Macaca fascicularis) to model menopause. OVX NHP were then divided into untreated (n = 13), conjugated equine estrogen (CEE)-treated (n= 13), or tamoxifen-treated (n = 13) subgroups and followed for 3 years. Aged-matched ovary-intact female NHP (n = 12) were used as a premenopausal comparison group. Metabolomics was performed on snap-frozen breast tissue. Results Changes in several different metabolic biochemicals were noted, particularly in glucose and fatty acid metabolism. Specifically, glycolytic, Krebs cycle, acylcarnitines, and phospholipid metabolites were elevated in breast tissue from ovary-intact NHP and OVX + CEE in relation to the OVX and OVX + tamoxifen group. In contrast, treatment with CEE and tamoxifen decreased several cholesterol metabolites, compared to the ovary-intact and OVX NHP. These changes were accompanied by elevated bile acid metabolites in the ovary-intact group. Conclusion Alterations in estrogen bioavailability are associated with changes in the mammary tissue metabolome, particularly in glucose and fatty acid metabolism. Changes in these pathways may represent a bioenergetic shift in gland metabolism at menopause that may affect breast cancer risk. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06354-w.
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Affiliation(s)
- Alana A Arnone
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC, 27157, USA.,Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - J Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - David R Soto-Pantoja
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Katherine L Cook
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. .,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. .,Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
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4
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Hyder T, Marino CC, Ahmad S, Nasrazadani A, Brufsky AM. Aromatase Inhibitor-Associated Musculoskeletal Syndrome: Understanding Mechanisms and Management. Front Endocrinol (Lausanne) 2021; 12:713700. [PMID: 34385978 PMCID: PMC8353230 DOI: 10.3389/fendo.2021.713700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/12/2021] [Indexed: 12/31/2022] Open
Abstract
Aromatase inhibitors (AIs) are a key component in the chemoprevention and treatment of hormone receptor-positive (HR+) breast cancer. While the addition of AI therapy has improved cancer-related outcomes in the management of HR+ breast cancer, AIs are associated with musculoskeletal adverse effects known as the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) that limit its tolerability and use. AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence. The pathophysiology of AIMSS is not fully understood though has been proposed to be related to estrogen deprivation within the musculoskeletal and nervous systems. This review aims to characterize the prevalence, risk factors, and clinical features of AIMSS, and explore the syndrome's underlying mechanisms and management strategies.
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Affiliation(s)
- Tara Hyder
- University of Pittsburgh Physicians, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christopher C Marino
- Mario Lemieux Center for Blood Cancers, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States
| | - Sasha Ahmad
- Department of Sciences, Sewickley Academy, Pittsburgh, PA, United States
| | - Azadeh Nasrazadani
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
| | - Adam M Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Pittsburgh, PA, United States
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5
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Watson KL, Sauerzopf K, Moorehead RA. Isolated Soy Protein Promotes Mammary Tumor Development Induced by the Type I Insulin-like Growth Factor Receptor in Transgenic Mice. Nutr Cancer 2020; 73:1340-1349. [PMID: 32692262 DOI: 10.1080/01635581.2020.1795210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Studies suggest consuming soy may protect women from breast cancer. In this study, lifetime exposure to 20%, 5% and 1% ISP in MTB-IGFIR mice (mammary-specific expression of IGF-IR) were evaluated to determine whether ISP could protect against mammary tumorigenesis. MTB-IGFIR mice fed ISP diets displayed increased mammary tumor incidence and reduced tumor latency compared to mice fed 20% casein. To evaluate whether a diet containing a less refined form of soy could protect against mammary tumor development MTB-IGFIR mice were fed Teklad 2018 (contains soybean meal). MTB-IGFIR mice fed the Teklad 2018 diet were completely protected against mammary tumor development. To determine whether dietary ISP was sufficient to induce mammary tumorigenesis, MTB-IGFIR mice were fed Teklad 2018ISP (soybean meal of Teklad 2018 was replaced with an equivalent amount of ISP). Only two of 10 MTB-IGFIR mice fed Teklad 2018ISP developed mammary tumors. This study demonstrates the complex interaction between soy and other dietary components in modifying mammary tumor development.
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Affiliation(s)
- Katrina L Watson
- Department of Biomnedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Kristen Sauerzopf
- Department of Biomnedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Roger A Moorehead
- Department of Biomnedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Canada
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6
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Moorehead RA. Rodent Models Assessing Mammary Tumor Prevention by Soy or Soy Isoflavones. Genes (Basel) 2019; 10:E566. [PMID: 31357528 PMCID: PMC6722900 DOI: 10.3390/genes10080566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022] Open
Abstract
While epidemiological studies performed in Asian countries generally show that high levels of dietary soy are associated with reduced breast cancer risk, studies in Western countries have typically failed to show this correlation. In an attempt to model the preventative actions of soy on mammary tumor development, rodent models have been employed. Thirty-four studies were identified that evaluated the impact of soy products or purified soy isoflavones on mammary tumor initiation (studies evaluating established mammary tumors or mammary tumor cell lines were not included) and these studies were separated into mammary tumors induced by chemical carcinogens or transgenic expression of oncogenes based on the timing of soy administration. Regardless of when soy-based diets or purified isoflavones were administered, no consistent protective effects were observed in either carcinogen-induced or oncogene-induced mammary tumors. While some studies demonstrated that soy or purified isoflavones could reduce mammary tumor incidence, other studies showed either no effect or tumor promoting effects of soy products or isoflavones. Most importantly, only five studies found a decrease in mammary tumor incidence and six studies observed a decrease in tumor multiplicity, two relevant measures of the tumor preventative effects of soy or isoflavones. The variable outcomes of the studies examined were not completely surprising given that few studies employed the same experimental design. Future studies should be carefully designed to more accurately emulate soy consumption observed in Asian cultures including lifetime exposure to less refined soy products and potentially the incorporation of multigenerational feeding studies.
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Affiliation(s)
- Roger A Moorehead
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G2W1, Canada.
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7
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Gonzalez TL, Moos RK, Gersch CL, Johnson MD, Richardson RJ, Koch HM, Rae JM. Metabolites of n-Butylparaben and iso-Butylparaben Exhibit Estrogenic Properties in MCF-7 and T47D Human Breast Cancer Cell Lines. Toxicol Sci 2019; 164:50-59. [PMID: 29945225 DOI: 10.1093/toxsci/kfy063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Two oxidized metabolites of n-butylparaben (BuP) and iso-butylparaben (IsoBuP) discovered in human urine samples exhibit structural similarity to endogenous estrogens. We hypothesized that these metabolites bind to the human estrogen receptor (ER) and promote estrogen signaling. We tested this using models of ER-mediated cellular proliferation. The estrogenic properties of 3-hydroxy n-butyl 4-hydroxybenzoate (3OH) and 2-hydroxy iso-butyl 4-hydroxybenzoate (2OH) were determined using the ER-positive, estrogen-dependent human breast cancer cell lines MCF-7, and T47D. The 3OH metabolite induced cellular proliferation with EC50 of 8.2 µM in MCF-7 cells. The EC50 for 3OH in T47D cells could not be reached. The 2OH metabolite induced proliferation with EC50 of 2.2 µM and 43.0 µM in MCF-7 and T47D cells, respectively. The EC50 for the parental IsoBuP and BuP was 0.30 and 1.2 µM in MCF-7 cells, respectively. The expression of a pro-proliferative, estrogen-inducible gene (GREB1) was induced by these compounds and blocked by co-administration of an ER antagonist (ICI 182, 780), confirming the ER-dependence of these effects. The metabolites promoted significant ER-dependent transcriptional activity of an ERE-luciferase reporter construct at 10 and 20 µM for 2OH and 10 µM for 3OH. Computational docking studies showed that the paraben compounds exhibited the potential for favorable ligand-binding domain interactions with human ERα in a manner similar to known x-ray crystal structures of 17ß-estradiol in complex with ERα. We conclude that the hydroxylated metabolites of BuP and IsoBuP are weak estrogens and should be considered as additional components of potential endocrine disrupting effects upon paraben exposure.
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Affiliation(s)
- Thomas L Gonzalez
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109
| | - Rebecca K Moos
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr Universität Bochum (IPA), Bochum 44789, Germany
| | - Christina L Gersch
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Michael D Johnson
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia 20057
| | - Rudy J Richardson
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109.,Department of Neurology, University of Michigan, Ann Arbor, Michigan 48109
| | - Holger M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr Universität Bochum (IPA), Bochum 44789, Germany
| | - James M Rae
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109
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8
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Gonzalez TL, Rae JM, Colacino JA. Implication of environmental estrogens on breast cancer treatment and progression. Toxicology 2019; 421:41-48. [PMID: 30940549 DOI: 10.1016/j.tox.2019.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/05/2019] [Accepted: 03/28/2019] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most diagnosed malignancy among women in the United States. Approximately 70% of breast tumors express estrogen receptor alpha and are deemed ER-positive. ER-positive breast tumors depend upon endogenous estrogens to promote ER-mediated cellular proliferation. Decades of research have led to a fundamental understanding of the role ER signaling in this disease and this knowledge has led to significant advancements in the clinical use of antiestrogens for breast cancer treatment. However, adjuvant breast cancer recurrence and metastatic disease progression due to endocrine therapy resistance are prominent and unresolved issues. The established role that estrogens play in breast cancer pathogenesis explains why some patients initially respond to endocrine therapy but also why a significant number of patients become refractory to antiestrogen treatment. It is been hypothesized that exposure to environmental steroid hormone mimics and/or acquired mechanisms of resistance may explain why endocrine therapy fails in a subset of breast cancer patients. This review will highlight: 1) the relationship between ER signaling and breast cancer pathogenesis, 2) the implication of environmental exposures on steroid hormone regulated processes including breast cancer, and 3) the unresolved issue of endocrine therapy resistance.
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Affiliation(s)
- Thomas L Gonzalez
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA.
| | - James M Rae
- Division of Hematology/ Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
| | - Justin A Colacino
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA.
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9
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Andò S, Gelsomino L, Panza S, Giordano C, Bonofiglio D, Barone I, Catalano S. Obesity, Leptin and Breast Cancer: Epidemiological Evidence and Proposed Mechanisms. Cancers (Basel) 2019; 11:cancers11010062. [PMID: 30634494 PMCID: PMC6356310 DOI: 10.3390/cancers11010062] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023] Open
Abstract
The prevalence of obesity has been steadily increasing over the past few decades in several developed and developing countries, with resultant hazardous health implications. Substantial epidemiological evidence has shown that excessive adiposity strongly influences risk, prognosis, and progression of various malignancies, including breast cancer. Indeed, it is now well recognized that obesity is a complex physiologic state associated with multiple molecular changes capable of modulating the behavior of breast tumor cells as well of the surrounding microenvironment. Particularly, insulin resistance, hyperactivation of insulin-like growth factor pathways, and increased levels of estrogen due to aromatization by the adipose tissue, inflammatory cytokines, and adipokines contribute to breast cancerogenesis. Among adipokines, leptin, whose circulating levels increase proportionally to total adipose tissue mass, has been identified as a key member of the molecular network in obesity. This review summarizes the current knowledge on the epidemiological link existing between obesity and breast cancer and outlines the molecular mechanisms underlying this connection. The multifaceted role of the obesity adipokine leptin in this respect is also discussed.
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Affiliation(s)
- Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
- Centro Sanitario, University of Calabria, Via P Bucci, 87036 Arcavacata di Rende (CS), Italy.
| | - Luca Gelsomino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
| | - Salvatore Panza
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
| | - Cinzia Giordano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
- Centro Sanitario, University of Calabria, Via P Bucci, 87036 Arcavacata di Rende (CS), Italy.
| | - Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
| | - Ines Barone
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende (CS), Italy.
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Hughes TM, Palmer EN, Capers Q, Abdel-Misih S, Harzmann A, Beal E, Woelfel I, Noria S, Agnese D, Dillhoff M, Grignol V, Howard JH, Shirley LA, Terando A, Schmidt C, Cloyd J, Pawlik T. Practices and Perceptions Among Surgical Oncologists in the Perioperative Care of Obese Cancer Patients. Ann Surg Oncol 2018; 25:2513-2519. [DOI: 10.1245/s10434-018-6564-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Indexed: 12/31/2022]
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11
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Elwood JM, Tin Tin S, Kuper-Hommel M, Lawrenson R, Campbell I. Obesity and breast cancer outcomes in chemotherapy patients in New Zealand - a population-based cohort study. BMC Cancer 2018; 18:76. [PMID: 29334917 PMCID: PMC5769510 DOI: 10.1186/s12885-017-3971-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/21/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Obesity has been reported as an adverse prognostic factor in breast cancer, but inconsistently, and under-treatment with chemotherapy may occur. We provide the first assessment of obesity and breast cancer outcomes in a population-based, multi-ethnic cohort of New Zealand patients treated with chemotherapy. METHODS All 3536 women diagnosed with invasive breast cancer in the Waikato region of New Zealand from 2000-2014 were registered and followed until last follow-up in specialist or primary care, death or Dec 2014; median follow-up 4.1 years. For the 1049 patients receiving chemotherapy, mortality from breast cancer, other causes, and all causes, and rates of loco-regional and of distant recurrence, were assessed by body mass index (BMI), recorded after diagnosis, adjusting for other clinico-pathological and demographic factors by Cox regression. RESULTS BMI was known for 98% (n=1049); 33% were overweight (BMI 25-29.9), 21% were obese (BMI 30-34.9), and 14% were very obese (BMI 35+). There were no significant associations between obesity and survival, after adjustment for demographic and clinical factors (hazard ratios, HR, for very obese compared to BMI 21-24, for breast cancer deaths 0.96 (0.56-1.67), and for all deaths 1.03 (0.63-1.67), respectively, and only small non-significant associations for loco-regional or metastatic recurrence rates (HR 1.17 and 1.33 respectively). Subgroup analyses by age, menopausal status, ethnicity, stage, post-surgical radiotherapy, mode of diagnosis, type of surgery, and receptor status, showed no associations. No associations were seen with BMI as a continuous variable. The results in all patients irrespective of treatment but with recorded BMI data (n=2296) showed similar results. CONCLUSIONS In this population, obesity assessed post-diagnosis had no effect on survival or recurrence, based on 1049 patients with chemotherapy treatment with follow-up up to 14 years.
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Affiliation(s)
- J Mark Elwood
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland, Auckland Mail Centre, 1142, New Zealand.
| | - Sandar Tin Tin
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, 261 Morrin Road, Private Bag 92019, Auckland, Auckland Mail Centre, 1142, New Zealand
| | | | - Ross Lawrenson
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.,National Institute of Demographic and Economic Analysis, The University of Waikato, Hamilton, 3240, New Zealand
| | - Ian Campbell
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
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12
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Vega S, Basurto L, Saucedo R, Barrera S, Reyes-Maldonado E, Garcia-Latorre EA, Zarate A. Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:186-192. [PMID: 28927816 DOI: 10.1016/j.jogc.2017.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. METHODS A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. RESULTS The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. CONCLUSION Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.
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Affiliation(s)
- Sara Vega
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lourdes Basurto
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Renata Saucedo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Susana Barrera
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elba Reyes-Maldonado
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Ethel A Garcia-Latorre
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Arturo Zarate
- Unidad de Investigación Médica en Enfermedades Endocrinas, Diabetes y Metabolismo, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Hsu JC, Chang SM, Lu CY. Geographic Variations and Time Trends in Cancer Treatments in Taiwan. BMC Public Health 2017; 18:89. [PMID: 28768504 PMCID: PMC5541736 DOI: 10.1186/s12889-017-4615-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 07/20/2017] [Indexed: 01/25/2023] Open
Abstract
Background Targeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands). Methods This was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan’s National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends. Results Population-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments. Conclusions Use of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies.
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Affiliation(s)
- Jason C Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan, 70101, Taiwan.
| | - Sheng-Mao Chang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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14
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Carroll JS, Hickey TE, Tarulli GA, Williams M, Tilley WD. Deciphering the divergent roles of progestogens in breast cancer. Nat Rev Cancer 2017; 17:54-64. [PMID: 27885264 DOI: 10.1038/nrc.2016.116] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most breast cancers are driven by oestrogen receptor-α. Anti-oestrogenic drugs are the standard treatment for these breast cancers; however, treatment resistance is common, necessitating new therapeutic strategies. Recent preclinical and historical clinical studies support the use of progestogens to activate the progesterone receptor (PR) in breast cancers. However, widespread controversy exists regarding the role of progestogens in this disease, hindering the clinical implementation of PR-targeted therapies. Herein, we present and discuss data at the root of this controversy and clarify the confusion and misinterpretations that have consequently arisen. We then present our view on how progestogens may be safely and effectively used in treating breast cancer.
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Affiliation(s)
- Jason S Carroll
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge CB2 0RE, UK
| | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories, Hanson Institute and School of Medicine, University of Adelaide, Adelaide SA 5005, Australia
| | - Gerard A Tarulli
- Dame Roma Mitchell Cancer Research Laboratories, Hanson Institute and School of Medicine, University of Adelaide, Adelaide SA 5005, Australia
| | - Michael Williams
- Division of Epidemiology, Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098, USA
| | - Wayne D Tilley
- Dame Roma Mitchell Cancer Research Laboratories, Hanson Institute and School of Medicine, University of Adelaide, Adelaide SA 5005, Australia
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15
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Harvie M, Howell T. Need for Weight Management among Postmenopausal Early Breast Cancer Patients Receiving Adjuvant Endocrine Therapy. WOMENS HEALTH 2016; 1:205-22. [DOI: 10.2217/17455057.1.2.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Increasingly effective adjuvant therapies mean that the prognosis for postmenopausal women with breast cancer has never been better. Weight problems are common among breast cancer patients and worsen due to the impact of diagnosis and treatment. Recent studies have linked excess weight with the risk of recurrence of breast cancer among premenopausal women. While general obesity (body mass index) does not appear to influence the already much improved prognosis for postmenopausal women, there is some evidence that limiting central obesity and improving insulin resistance may improve survival. The focus of attention for postmenopausal breast cancer survivors is also shifting to consider the mortality and morbidity from other weight-related cancers and noncancer causes, such as cardiovascular disease, making weight control a potentially important adjunct to endocrine therapy. This paper outlines the rationale and optimal design for effective weight management strategies among postmenopausal breast cancer patients receiving endocrine therapy.
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Affiliation(s)
- Michelle Harvie
- CRUK University Department of Medical Oncology Christie Hospital, Christie Hospital Wilmslow road Manchester M20 4BX, Tel.: +44 161 446 8037; Fax: +44 161 446 8000
| | - Tony Howell
- CRUK University Department of Medical Oncology Christie Hospital, Christie Hospital Wilmslow road Manchester M20 4BX, Tel.: +44 161 446 8037; Fax: +44 161 446 8000
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16
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Vogel VG. Raloxifene: A Selective Estrogen Receptor Modulator for Reducing the Risk of Invasive Breast Cancer in Postmenopausal Women. WOMENS HEALTH 2016; 3:139-53. [DOI: 10.2217/17455057.3.2.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Raloxifene hydrochloride is a selective estrogen receptor modulator that has antiestrogenic effects on breast and endometrial tissue and estrogenic effects on bone, lipid metabolism and blood clotting. Tamoxifen is the prototypical selective estrogen receptor modulator and reduces the risk of both in situ and invasive breast cancers by half when compared with placebo. The limitations on the use of tamoxifen for breast cancer risk reduction relate to its well-known, but rare, side effects. A number of clinical trials have established the benefit of raloxifene on osteoporosis and fracture. Raloxifene significantly improves serum lipids and serum markers of cardiovascular disease risk, but has no significant effect on the risk of primary coronary events. In several osteoporosis trials and the Raloxifene Use for The Heart (RUTH) trial, raloxifene decreased the risk of estrogen receptor-positive breast cancer by 44–90%. In the Study of Tamoxifen And Raloxifene (STAR) trial, the effect of raloxifene on invasive breast cancer was equivalent to that of tamoxifen, with more favorable effects on uterine malignancy and clotting events. Symptomatic side effects are acceptable. In total, the available data indicate that raloxifene represents an acceptable alternative to tamoxifen for the reduction of the risk of postmenopausal breast cancer in high-risk women. The potential market for a compound shown to reduce the risk of breast cancer in postmenopausal women who are at increased risk for breast cancer is more than 10 million women in the USA alone.
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Affiliation(s)
- Victor G Vogel
- UPMC Cancer Center Magee-Women's Hospital, 300 Halket Street, Room 3524, Pittsburgh, PA 15213, USA, Tel.: +1 412 641 6500; Fax: +1 412 641 6461
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17
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Col NF. The Use of Gene Tests to Detect Hereditary Predisposition to Chronic Disease: Is Cost-Effectiveness Analysis Relevant? Med Decis Making 2016; 23:441-8. [PMID: 14570302 DOI: 10.1177/0272989x03254456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Screening for genetic susceptibility provides new opportunities for preventing common diseases, but whether such screening will result in substantial costs or savings is unclear. Cost-effectiveness analyses (CEAs) provide a theoretical framework for guiding clinical decisions about genetic tests. However, CEAs have been largely irrelevant in informing policy, clinical decisions, or patient demand concerning these genetic tests. Genetic tests have often proceeded directly from development and preliminary validation into clinical practice, with little understanding of their clinical, economic, and psychosocial implications. Using screening for BRCA mutations as an example, the accuracy of the tests and the effectiveness of many interventions among those who screen positive remain in question. CEAs do not seem to have played an important role in identifying whom to offer genetic testing nor how to manage those found to carry the gene marker. Credible CEAs are needed to provide guidance about screening decisions.
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Affiliation(s)
- Nananda F Col
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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18
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Wu X, Wang M, Li S, Zhang Y. Migraine and breast cancer risk: a meta-analysis of observational studies based on MOOSE compliant. Medicine (Baltimore) 2016; 95:e4031. [PMID: 27472675 PMCID: PMC5265812 DOI: 10.1097/md.0000000000004031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It has long been speculated that migraine may contribute to an increased risk of breast cancer; however, results from previous studies have been inconclusive. To definitively interrogate this issue, we performed a meta-analysis to assess the correlation between these 2 diseases.Medline and PubMed were searched to identify relevant studies that had been published until October 2015. Based on a random effects model, relative risk (RR) and the corresponding 95% confidence interval (CI) were used to evaluate the pooled risk.A total of 7 studies involving 17,776 cases and 162,954 participants were included. Our study revealed that there was an inverse relationship between migraine and total breast cancer risk, with RR (95%CI) was 0.78 (0.66, 0.92). In subgroup-analysis, such an inverse relationship was also identified in the ductal and lobular carcinoma, case-control studies, and the ER/PR breast cancer. Little evidence indicative of a publication bias was uncovered.In conclusion, our study implicates a statistically significant inverse association between migraine and the risk of breast cancer. However, larger prospective cohort studies concerning other geographic populations to assess the association between migraine and the breast cancer risk are warranted.
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Affiliation(s)
| | | | | | - Yi Zhang
- Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing, China
- Correspondence to Yi Zhang, Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing, China (e-mail: )
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19
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Phase I biomarker modulation study of atorvastatin in women at increased risk for breast cancer. Breast Cancer Res Treat 2016; 158:67-77. [PMID: 27287781 DOI: 10.1007/s10549-016-3849-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/28/2016] [Indexed: 02/04/2023]
Abstract
Selective estrogen receptor modulators (SERMs), tamoxifen, and raloxifene that reduce the risk of breast cancer are limited to only estrogen receptor-positive (ER(+)) breast cancer. In addition, patient acceptance of SERMs is low due to toxicity and intolerability. New agents with improved toxicity profile that reduce risk of ER-negative breast cancer are urgently needed. Observational studies show that statins can reduce breast cancer incidence and recurrence. The objective of this prospective short-term prevention study was to evaluate the effect of a lipophilic statin, atorvastatin, on biomarkers in breast tissue and serum of women at increased risk. Eligible participants included women with previous history of carcinoma in situ, or atypical hyperplasia, or 5 year breast cancer projected Gail risk >1.67 %, or lifetime breast cancer risk >20 % calculated by models including Claus, Tyrer-Cuzick, Boadicea, or BRCAPRO. Patients underwent baseline fine needle aspiration (FNA) of the breast, blood collection for biomarker analysis, and were randomized to either no treatment or atorvastatin at 10, 20, or 40 mg/day dose for 3 months. At 3 months, blood collection and breast FNA were repeated. Biomarkers included C-reactive protein (CRP), lipid profile, atorvastatin, and its metabolites, Ki-67, bcl-2, EGFR, and pEGFR. Baseline genotype for 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoAR) was also measured. Among 60 patients evaluated, a significant reduction in serum CRP, cholesterol and low-density lipoprotein (LDL), and increase in atorvastatin metabolites in serum and breast FNAs was demonstrated. No changes were observed in other tissue biomarkers. This study shows that atorvastatin and its metabolites are detectable in breast samples and may lower serum CRP among women without hyperlipidemia.
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20
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Minasian LM, Tangen CM, Wickerham DL. Ongoing Use of Data and Specimens From National Cancer Institute-Sponsored Cancer Prevention Clinical Trials in the Community Clinical Oncology Program. Semin Oncol 2015; 42:748-63. [PMID: 26433556 DOI: 10.1053/j.seminoncol.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Large cancer prevention trials provide opportunities to collect a wide array of data and biospecimens at study entry and longitudinally, for a healthy, aging population without cancer. This provides an opportunity to use pre-diagnostic data and specimens to evaluate hypotheses about the initial development of cancer. We report on strides made by, and future possibilities for, the use of accessible biorepositories developed from precisely annotated samples obtained through large-scale National Cancer Institute (NCI)-sponsored cancer prevention clinical trials conducted by the NCI Cooperative Groups. These large cancer prevention studies, which have enrolled more than 80,000 volunteers, continue to contribute to our understanding of cancer development more than 10 years after they were closed.
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Affiliation(s)
- Lori M Minasian
- Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD.
| | - Catherine M Tangen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - D Lawrence Wickerham
- Department of Human Oncology, Pittsburgh Campus of Temple University School of Medicine, Pittsburgh, PA
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21
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DeCensi A, Bonanni B, Maisonneuve P, Serrano D, Omodei U, Varricchio C, Cazzaniga M, Lazzeroni M, Rotmensz N, Santillo B, Sideri M, Cassano E, Belloni C, Muraca M, Segnan N, Masullo P, Costa A, Monti N, Vella A, Bisanti L, D'Aiuto G, Veronesi U. A phase-III prevention trial of low-dose tamoxifen in postmenopausal hormone replacement therapy users: the HOT study. Ann Oncol 2013; 24:2753-60. [DOI: 10.1093/annonc/mdt244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Does estrogen play a role in response to adjuvant bone-targeted therapies? J Bone Oncol 2013; 2:167-73. [PMID: 26909288 PMCID: PMC4723380 DOI: 10.1016/j.jbo.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/21/2013] [Accepted: 06/30/2013] [Indexed: 12/29/2022] Open
Abstract
Bone remains the most common site of breast cancer recurrence. The results of population studies, pre-clinical research and clinical studies in patients with metastatic disease provided a rationale for testing bone-targeted agents in the adjuvant setting. Despite the initial optimism, results from eight prospectively designed, randomized control studies powered to assess the value of adjuvant bone-targeted therapy in early breast cancer are conflicting. Data have shown that, where benefit exists, it tends to be in women with a “low estrogen environment”, either through menopause or suppression of ovarian function. In this manuscript, we review clinical data supporting the hypothesis that estrogen levels may play a part in explaining the response of patients to bone-targeted agents in the adjuvant setting. The results presented to date suggest that there may be data supporting a unifying role for estrogen in adjuvant trials. However, in the absence of any prospective randomized trials in which estrogen data has been systematically collected we cannot specifically answer this question. We await the results of the Oxford overview analysis of individual patient data with interest.
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23
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Bozovic-Spasojevic I, Azambuja E, McCaskill-Stevens W, Dinh P, Cardoso F. Chemoprevention for breast cancer. Cancer Treat Rev 2012; 38:329-39. [PMID: 21856081 DOI: 10.1016/j.ctrv.2011.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 01/11/2023]
Abstract
Despite the progress that has been made in breast cancer diagnosis and treatment, this disease is still a major health problem, being the most frequently diagnosed cancer and the first leading cause of cancer death among women both in developed and economically developing countries. In some developed countries incidence rate start to decrease from the end of last millennium and this can be explained, at least in part, by the decrease in hormone replacement therapy use by post-menopausal women. Chemoprevention has the potential to be an approach of utmost importance to reduce cancer burden at least among high-risk populations. Tamoxifen and raloxifene are both indicated for the prevention of breast cancer in women at high risk for the development of the disease, although raloxifene may have a more favorable adverse-effect profile, causing fewer uterine cancers and thromboembolic events. Aromatase inhibitors will most probably become an additional prevention treatment option in the near future, in view of the promising results observed in adjuvant trials and the interesting results of the very recently published first chemoprevention trial using an aromatase inhibitor.(2) Despite impressive results in most clinical trials performed to date, chemoprevention is still not widely used. Urgently needed are better molecular risk models to accurately identify high-risk subjects, new agents with a better risk/benefit ratio and validated biomarkers.
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Affiliation(s)
- I Bozovic-Spasojevic
- BIG - Breast International Group, Institut Jules Bordet, 121 Blvd. de Waterloo, 1000 Brussels, Belgium.
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24
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Bundred NJ, Kenemans P, Yip CH, Beckmann MW, Foidart JM, Sismondi P, Schoultz BV, Vassilopoulou-Sellin R, Galta RE, Lieshout EV, Mol-Arts M, Planellas J, Kubista E. Tibolone increases bone mineral density but also relapse in breast cancer survivors: LIBERATE trial bone substudy. Breast Cancer Res 2012; 14:R13. [PMID: 22251615 PMCID: PMC3496130 DOI: 10.1186/bcr3097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/10/2011] [Accepted: 01/17/2012] [Indexed: 02/26/2023] Open
Abstract
Introduction The Livial Intervention Following Breast Cancer: Efficacy, Recurrence and Tolerability Endpoints (LIBERATE: Clinical http://Trials.gov number NCT00408863), a randomized, placebo-controlled, double-blind trial that demonstrated that tibolone (Livial), a tissue-selective hormone-replacement therapy (HRT), increased breast cancer (BC) recurrence HR 1.40 (95% CI, 1.14 to 1.70; P = 0.001). A subgroup of women was entered into a study of bone mineral density (BMD). Methods Women with surgically excised primary BC (T1-3, N0-2, M-0) within the last 5 years, complaining of vasomotor symptoms, were assigned to tibolone, 2.5 mg daily, or placebo treatment for a maximum of 5 years. The BMD substudy enrolled 763 patients, using dual-energy X-ray absorptiometry (DXA) scanning at baseline and at 2 years. Results In the bone substudy, 699 of 763 women were eligible (345 allocated to tibolone, and 354, to placebo). After undergoing DXA scans, 300 (43%) women had normal BMD; 317 (45%), osteopenia; and 82 (11.7%), osteoporosis. Low body-mass index (P < 0.001), Asian race (P < 0.001), and late age at menarche (P < 0.04) predicted low bone mass at baseline. Tibolone increased BMD by 3.2% at the lumbar spine and 2.9% at the hip compared with placebo (both P < 0.001). The majority of fractures (55%) occurred in osteopenic patients. Women with normal BMD had increased recurrence with tibolone, 22 (15.6%) of 141 compared with placebo, 11 (6.9%) of 159 (P = 0.016), whereas no increased BC recurrence was seen in women with low BMD; 15 (7.4%) of 204 taking tibolone versus 13 (6.7%) of 195 taking placebo. Conclusions Tibolone is contraindicated after BC treatment, as it increases BMD and BC recurrence. Risk of BC recurrence was elevated in BC women with normal BMD (compared with low) who took tibolone.
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Affiliation(s)
- Nigel J Bundred
- Department of Surgery, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK.
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Shin A, Song YM, Yoo KY, Sung J. Menstrual factors and cancer risk among Korean women. Int J Epidemiol 2011; 40:1261-8. [PMID: 21841186 DOI: 10.1093/ije/dyr121] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It has been suggested that lifetime exposure to female hormones is related to cancer risk in women. The authors investigated the association between age at menarche and menopause and cancer risk in a prospective study of Korean women. METHODS A total of 443 909 women, in the age group of 30-80 years in the 1993-94 time period were included in the analysis. During 12 years of follow-up, 17 959 incident cancer cases were identified by record linkage to the Central Cancer Registry database. RESULTS Early age at menarche was associated with an increased risk of breast cancer and a decreased risk of stomach and gallbladder cancer. Later age at menopause was associated with an increased risk of breast cancer. When the analysis was restricted to post-menopausal women, the associations of age at menarche and menopause with cancers of the breast, stomach and gallbladder persisted. CONCLUSION These findings suggest that female hormonal factors play a significant role in the development of cancer in Korean women.
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Affiliation(s)
- Aesun Shin
- Cancer Epidemiology Branch, Division of Cancer Epidemiology and Management, Research Institute, National Cancer Center, Goyang-si, South Korea
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Dizdaroglu M, Reddy PT, Jaruga P. Identification and Quantification of DNA Repair Proteins by Liquid Chromatography/Isotope-Dilution Tandem Mass Spectrometry Using Their Fully 15N-Labeled Analogues as Internal Standards. J Proteome Res 2011; 10:3802-13. [DOI: 10.1021/pr200269j] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Miral Dizdaroglu
- Biochemical Science Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899-8311, United States
| | - Prasad T. Reddy
- Biochemical Science Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899-8311, United States
| | - Pawel Jaruga
- Biochemical Science Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899-8311, United States
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Vogel VG, Costantino JP, Wickerham DL, McCaskill-Stevens W, Clarfeld RB, Grant MD, Wolmark N. Carcinoma in situ outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials. J Natl Cancer Inst Monogr 2011; 2010:181-6. [PMID: 20956826 DOI: 10.1093/jncimonographs/lgq041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial (BCPT), the reduction in risk of noninvasive breast cancer was 50%. There were 93 cases in women receiving placebo and 60 in those receiving tamoxifen (P = .008). Through 7 years of follow-up, the cumulative incidence of noninvasive breast cancer among the placebo group was 15.8 per 1000 women vs 10.2 per 1000 women in the tamoxifen group. In the initial report of the Study of Tamoxifen and Raloxifene (STAR trial), the rate for noninvasive breast cancer was 1.51 per 1000 women assigned to tamoxifen and 2.11 per 1000 women assigned to raloxifene (risk ratio, 1.40; 95% confidence interval = 0.98 to 2.00). METHODS Additional follow-up of the NSABP STAR trial through March 31, 2009 is reported with a focus on noninvasive breast cancer events. RESULTS Through 81 months of median follow-up in the NSABP STAR trial, there are 137 cases of noninvasive breast cancer in the raloxifene group compared with 111 cases in the tamoxifen group (risk ratio = 1.02, 95% confidence interval = 0.61 to 1.70). The occurrence of ductal carcinoma in situ with raloxifene was seen more frequently among women with lower baseline Gail scores and no atypical hyperplasia than in women taking tamoxifen therapy. Raloxifene retained 76% of the effectiveness of tamoxifen in preventing invasive breast cancer. CONCLUSIONS Although these data indicate that raloxifene offers less protection than tamoxifen for postmenopausal women who are at increased risk for both invasive and noninvasive breast cancer, the favorable risk-benefit profile for raloxifene affords acceptable clinical reduction in the risk of in situ cancers among postmenopausal women.
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Affiliation(s)
- Victor G Vogel
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA.
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Englert NA, Spink BC, Spink DC. Persistent and non-persistent changes in gene expression result from long-term estrogen exposure of MCF-7 breast cancer cells. J Steroid Biochem Mol Biol 2011; 123:140-50. [PMID: 21185374 DOI: 10.1016/j.jsbmb.2010.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 12/19/2022]
Abstract
Life-long estrogen exposure is recognized as a major risk factor for the development of breast cancer. While the initial events in the regulation of gene expression by estrogen have been described in detail, far less is known of the role of estrogen in the long-term regulation of gene expression. In this study, we investigated the effects of long-term exposure of MCF-7 breast cancer cells to 1nM 17β-estradiol on gene expression with the goal of distinguishing between gene expression that is continually reliant on estrogen receptor (ER) function as opposed to secondary and persistent effects that are downstream of ER. To assess the direct involvement of ER in the differential gene expression of long-term estrogen exposed (LTEE) cells in comparison with that of control cells, we exposed cultures to the selective estrogen receptor modulator raloxifene (RAL). cDNA microarray analysis showed that exposure to RAL inhibited expression of numerous characterized estrogen-regulated genes, including PGR, GREB1, and PDZK1. Genes that were increased in expression in LTEE cells yet were unaffected by RAL exposure included the aryl hydrocarbon receptor (AHR) and numerous other genes that were not previously reported to be regulated by estrogen. Epigenetic regulation was evident for the AHR gene; AhR transcript levels remained elevated for several cell passages after the removal of estrogen. Signal transducer and activator of transcription 1 (STAT1); STAT1-regulated genes including ISG15, IFI27, and IFIT1; and MHC class I genes were also up-regulated in LTEE cells and were unaffected by RAL exposure. STAT1 is commonly overexpressed in breast and other cancers, and is associated with increased resistance to radiation and chemotherapy. This is the first study to relate estrogen exposure to increased STAT1 expression in breast cancer cells, an effect that may represent an additional role of estrogen in the pathogenesis of breast cancer.
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Affiliation(s)
- Neal A Englert
- Laboratory of Molecular Toxicology, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
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Yusuf R, Frenkel K. Morphologic transformation of human breast epithelial cells MCF-10A: dependence on an oxidative microenvironment and estrogen/epidermal growth factor receptors. Cancer Cell Int 2010; 10:30. [PMID: 20809984 PMCID: PMC2944135 DOI: 10.1186/1475-2867-10-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/01/2010] [Indexed: 11/19/2022] Open
Abstract
Background MCF-10A, immortalized but non-transformed human breast epithelial cells, are widely used in research examining carcinogenesis. The studies presented here were initiated with the observation that MCF-10A cells left in continuous culture for prolonged periods without re-feeding were prone to the development of transformed foci. We hypothesized that the depletion of labile culture components led to the onset of processes culminating in the observed cell transformation. The purpose of this study was to define the factors which promoted transformation of this cell line. Results Changes in levels of phenol red (PHR), hydrocortisone (HC), and epidermal growth factor (EGF) with or without estrogen treatment indicated that both oxidative stress- and estrogen receptor alpha (ERα)-mediated pathways contribute to cell transformation. Gene array and Western blotting analyses of cells maintained in our laboratory and of those from other sources documented detectable ERα and ERbeta (ERβ) in this ERα-negative cataloged cell line. Results also indicate the possibility of a direct association of EGF receptor (EGFR) and ERα in these cells as well as the formation and high induction of a novel ternary complex that includes ERβ (ERα/ERβ/EGFR) in cells grown under conditions facilitating transformation. Conclusions Our studies resulted in the development of a growth protocol where the effects of chronic, physiologically relevant alterations in the microenvironment on cellular transformation were examined. From our results, we were able to propose a model of transformation within the MCF-10A cell line in which oxidative stress, ER and EGFR play essential roles. Overall, our work indicates that the immediate microenvironment of cells exerts powerful growth cues which ultimately determine their transformation potential.
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Affiliation(s)
- Rita Yusuf
- Department of Environmental Medicine, NYU School of Medicine, PHL Room 802, 550 First Avenue, New York, NY 10016, USA.
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Ohsfeldt RL. Estimating the cost effectiveness of alternative drug treatments for postmenopausal osteoporosis. Expert Rev Pharmacoecon Outcomes Res 2010; 4:637-44. [PMID: 19807537 DOI: 10.1586/14737167.4.6.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The burden of postmenopausal osteoporosis is substantial and is likely to grow as the baby-boom generation ages. A greater understanding of the costs and clinical benefits of alternative therapies for postmenopausal osteoporosis is needed to develop informed health policies to reduce the future burden of osteoporosis. However, much of the data needed to evaluate the cost effectiveness of alternative therapies for postmenopausal osteoporosis are not available from clinical trials. Thus, cost-effectiveness models must cope with a high degree of uncertainty. This article provides a brief summary of the methodologic issues in cost-effectiveness analyses of current osteoporosis therapies, a review of the findings in published cost-effectiveness studies, and a discussion of challenges likely to be encountered in future economic evaluations of emerging osteoporosis therapies.
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Affiliation(s)
- Robert L Ohsfeldt
- University of Iowa, College of Public Health, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J. Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 2010; 28:3411-5. [PMID: 20547990 DOI: 10.1200/jco.2009.27.2021] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Third-generation aromatase inhibitors have been widely used in postmenopausal women for the adjuvant treatment of hormone receptor-positive breast cancer. As aromatase inhibitors work by inhibiting the conversion of androgens to estrogens in adipose tissue, we hypothesized that anastrozole may be more effective in women with a high body mass index (BMI). PATIENTS AND METHODS The Arimidex, Tamoxifen Alone or in Combination (ATAC) study was a double-blind randomized clinical trial in which postmenopausal women with early-stage breast cancer were randomly assigned to receive oral daily anastrozole (1 mg) alone, tamoxifen (20 mg) alone, or the combination in a double-blind fashion. Analyses were based on the 100-month median follow-up for women with hormone receptor-positive breast cancers (estrogen [ER] and/or progesterone [PgR] positive). Here, we investigate the impact of BMI on recurrence and the relative benefit of anastrozole versus tamoxifen according to baseline BMI. Results Overall, women with a high BMI (BMI > 35 kg/m(2)) at baseline had more recurrences than those women with a low BMI (BMI < 23 kg/m(2); adjusted hazard ratio [HR], 1.39; 95% CI, 1.06 to 1.82; P(heterogeneity) = .03) and significantly more distant recurrences (adjusted HR, 1.46; 95% CI, 1.07 to 1.61; P(heterogeneity) = .01). Overall, the relative benefit of anastrozole versus tamoxifen was nonsignificantly better in thin women compared to overweight women. CONCLUSION These results confirm the poorer prognosis of obese women with early-stage breast cancer. Recurrence rates were lower for anastrozole than tamoxifen for all BMI quintiles. Our results suggest that the relative efficacy of anastrozole compared to tamoxifen is greater in thin postmenopausal women and higher doses or more complete inhibitors might be more effective in overweight women, but this requires independent confirmation.
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Affiliation(s)
- Ivana Sestak
- Cancer Research UK UK, Queen Mary University of London, London, United Kingdom.
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Aiyer HS, Gupta RC. Berries and ellagic acid prevent estrogen-induced mammary tumorigenesis by modulating enzymes of estrogen metabolism. Cancer Prev Res (Phila) 2010; 3:727-37. [PMID: 20501861 DOI: 10.1158/1940-6207.capr-09-0260] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To determine whether dietary berries and ellagic acid prevent 17beta-estradiol (E(2))-induced mammary tumors by altering estrogen metabolism, we randomized August-Copenhagen Irish rats (n = 6 per group) into five groups: sham implant + control diet, E(2) implant + control diet (E(2)-CD), E(2) + 2.5% black raspberry (E(2)-BRB), E(2) + 2.5% blueberry (E(2)-BB), and E(2) + 400 ppm ellagic acid (E(2)-EA). Animals were euthanized at early (6 wk), intermediate (18 wk), and late (24 wk) phases of E(2) carcinogenesis, and the mammary tissue was analyzed for gene expression changes using quantitative real-time PCR. At 6 weeks, E(2) treatment caused a 48-fold increase in cytochrome P450 1A1 (CYP1A1; P < 0.0001), which was attenuated by both BRB and BB diets to 12- and 21-fold, respectively (P < 0.001). E(2) did not alter CYP1B1 levels, but both berry and EA diets significantly suppressed it by 11- and 3.5-fold, respectively, from baseline (P < 0.05). There was a 5-fold increase in 17beta-hydroxysteroid dehydrogenase 7 (17betaHSD7), and this was moderately abrogated to approximately 2-fold by all supplementation (P < 0.05). At 18 weeks, CYP1A1 was elevated by 15-fold in E(2)-CD and only E(2)-BB reduced this increase to 7-fold (P < 0.05). Catechol-O-methyltransferase expression was elevated 2-fold by E(2) treatment (P < 0.05), and all supplementation reversed this. At 24 weeks, CYP1A1 expression was less pronounced but still high (8-fold) in E(2)-treated rats. This increase was reduced to 3.2- and 4.6-fold by E(2)-BRB and E(2)-EA, respectively (P < 0.05), but not by E(2)-BB. Supplementation did not alter the effect of E(2) on steroid receptors. The diets also significantly suppressed mammary tumor incidence (10-30%), volume (41-67%), and multiplicity (38-51%; P < 0.05). Berries may prevent mammary tumors by suppressing the levels of E(2)-metabolizing enzymes during the early phase of E(2) carcinogenesis.
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Affiliation(s)
- Harini S Aiyer
- James Graham Brown Cancer Center, University of Louisville, KY 40202, USA
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Abstract
OBJECTIVE Women without versus those with vertebral fracture may have different benefits and risks during raloxifene treatment. Our objective was to compare the effects of raloxifene to decrease risk for vertebral fracture and invasive breast cancer with its effect to increase risk for venous thromboembolism in postmenopausal women without or with baseline vertebral fracture. RESEARCH DESIGN AND METHODS The Multiple Outcomes of Raloxifene Evaluation trial included postmenopausal women with osteoporosis randomized to placebo, raloxifene 60 mg/day, or raloxifene 120 mg/day for 4 years. The protocol specified subgroups based on whether or not patients had a vertebral fracture at baseline. Absolute differences between placebo and raloxifene 60 mg/day (the approved dose) for endpoints in these groups were defined as the incidence in the raloxifene group minus the incidence in the placebo group. RESULTS Raloxifene decreased the incidence of vertebral fracture and invasive breast cancer while increasing the incidence of venous thromboembolism. All treatment by vertebral fracture status interaction p-values were greater than 0.13, indicating that the effect of raloxifene on these outcomes was not significantly different between patients without versus those with vertebral fractures. In women without baseline vertebral fracture, absolute risk differences between the raloxifene and placebo group included vertebral fracture -2.83%, invasive breast cancer -1.21%, and venous thromboembolism +0.28%. In women with baseline vertebral fracture, absolute risk differences between raloxifene and placebo group included vertebral fracture -8.21%, invasive breast cancer -0.75% and venous thromboembolism +0.91%. The analysis had limited power to test whether raloxifene had a significantly different effect on venous thromboembolism in women without versus those with a vertebral fracture. CONCLUSIONS In women without and in those with vertebral fractures at baseline, the effects of raloxifene to decrease vertebral fracture and invasive breast cancer were greater than its effects to increase venous thromboembolism.
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Nath A, Sitruk-Ware R. Pharmacology and clinical applications of selective estrogen receptor modulators. Climacteric 2009; 12:188-205. [PMID: 19387883 DOI: 10.1080/13697130802657896] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Compounds that can be described as selective estrogen receptor modulators (SERMs) have expanded dramatically over the past two decades. The ability of SERMs to act as estrogens in certain tissues while remaining inert or acting as an anti-estrogen in other tissues has opened up opportunities for treating specific estrogen-modulated diseases without accepting the risk of systemic estrogen activity. SERM development has resulted in significant therapeutic advances for breast cancer, osteoporosis and potentially other diseases associated with the menopause. After the publication of the Women's Health Initiative, interest in compound selectivity that reduces menopausal symptoms while protecting bone, breast, uterus and the heart has increased. Future SERMs may also have a therapeutic profile that can be tailored to specific patient populations, including men. This review paper summarizes the characteristics of different SERMs from various pharmacological categories and the feasibility and scope of their use for a large range of disease/health conditions.
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Affiliation(s)
- A Nath
- Population Council, New York, NY 10065, USA
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Vogel VG. Managing the risk of invasive breast cancer in women at risk for breast cancer and osteoporosis: the role of raloxifene. Clin Interv Aging 2009; 3:601-9. [PMID: 19281053 PMCID: PMC2682393 DOI: 10.2147/cia.s3344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Raloxifene hydrochloride is a selective estrogen receptor modulator (SERM) that has antiestrogenic effects on breast and endometrial tissue and estrogenic effects on bone, lipid metabolism, and blood clotting. Raloxifene significantly improves serum lipids and serum markers of cardiovascular disease risk, but it has no significant effect on the risk of primary coronary events. A meta-analysis of randomized, double-blind, placebo-controlled trials of raloxifene for osteoporosis showed the odds of fracture risk were 0.60 (95% confidence interval [CI] = 0.49–0.74) for raloxifene 60 mg/day compared with placebo. During 8 years of follow-up in an osteoporosis trial, the raloxifene group had a 76% reduction in the incidence of invasive ER-positive breast cancer compared with the placebo group. In the STAR trial, the incidence of invasive breast cancer was 4.30 per 1000 women-years with raloxifene and 4.41 per 1000 with tamoxifen; RR = 1.02; 95% CI, 0.82–1.28. The effect of raloxifene on invasive breast cancer was, therefore, equivalent to that of tamoxifen with more favorable rates of adverse effects including uterine malignancy and clotting events. Millions of postmenopausal women could derive net benefit from raloxifene through reduced rates of fracture and invasive breast cancer.
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Affiliation(s)
- Victor G Vogel
- The University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Abstract
In the Study of Tamoxifen and Raloxifene (STAR) trial, postmenopausal women at increased risk of breast cancer received either oral tamoxifen (20 mg/day) or raloxifene (60 mg/day) over 5 years. There were an equal number of cases of invasive breast cancer in women assigned to tamoxifen and raloxifene. There were fewer cases of noninvasive breast cancer in the tamoxifen group than in the raloxifene group (risk ratio [RR]: 1.40; 95% confidence interval [CI]: 0.98-2.02). There were more cases of uterine cancer with tamoxifen than with raloxifene (RR: 0.62; 95% CI: 0.35-1.08). Thromboembolic events occurred less often in the raloxifene group (RR: 0.70; 95% CI: 0.54-0.91) and there were fewer cataracts and cataract surgeries in the women taking raloxifene (RR: 0.79; 95% CI: 0.68-0.92). The STAR trial has shown that raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer and has a lower risk of adverse events but a nonstatistically significant higher risk of noninvasive breast cancer. The risk of other cancers, fractures, ischemic heart disease and stroke is similar for both drugs.
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Affiliation(s)
- Victor G Vogel
- University of Pittsburgh Cancer Institute, Magee-Womens Hospital, Pittsburgh, PA 15213-3180, USA.
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Aiyer HS, Kichambare S, Gupta RC. Prevention of oxidative DNA damage by bioactive berry components. Nutr Cancer 2009; 60 Suppl 1:36-42. [PMID: 19003579 DOI: 10.1080/01635580802398448] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The hormone 17ss-estradiol (E(2)) causes oxidative DNA damage via redox cycling of its metabolites such as 4-hydroxy estradiol (4E(2)). In this study, ACI rats (8 wk old) were fed either AIN-93M diet or diets supplemented with 0.5% each of mixed berries (strawberry, blueberry, blackberry, and red and black raspberry), blueberry alone (BB; 2.5%), or ellagic acid (EA; 400 ppm) from 2 wk prior to and up to 12 wk of E(2) treatment. The liver DNA was analyzed for the presence of 8-oxo-7,8-dihydroguanine (8-oxodG) and other polar adducts by 32P-postlabeling. Compared to sham treatment, E(2) significantly increased the levels of both 8-oxodG and P-1 subgroup (259% and 214%, respectively; P< 0.05). EA diet significantly reduced E(2)-induced levels of 8-oxodG, P-1, P-2, and PL-1 by 79, 63, 44, and 67%, respectively (P< 0.001). BB diet also significantly reduced the levels of P-1, P-2, and PL-1 subgroups by 77, 43, and 68%, respectively (P< 0.001). Mixed berries were, however, ineffective. In addition, aqueous extracts of berries (2%) and EA (100 microM) were tested for their efficacy in diminishing oxidative DNA adducts induced by redox cycling of 4E(2) catalyzed by copper chloride in vitro. EA was the most efficacious (90%), followed by extracts of red raspberry (70%), blueberry, and strawberry (50% each; P< 0.001).
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Affiliation(s)
- Harini S Aiyer
- Brown Cancer Center, Delia Baxter II, Room 304E, 580 Preston Street, Louisville, KY 40202, USA
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Abstract
Raloxifene (Evista) is a second-generation selective estrogen receptor modulator (SERM) that functions as an estrogen antagonist on breast and uterine tissues, and an estrogen agonist on bone. It is available in many countries worldwide for the treatment and prevention of osteoporosis in postmenopausal women, and has also been approved in the US for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis or postmenopausal women at increased risk of invasive breast cancer.Raloxifene reduces the risk of invasive breast cancer in postmenopausal women at high risk of invasive breast cancer and in postmenopausal women with osteoporosis. In addition, it is a well established agent for the prevention and treatment of osteoporosis. There was no significant difference between raloxifene and tamoxifen in the reduction in the risk of invasive breast cancer achieved in postmenopausal women at high risk of such cancer. Raloxifene was associated with an increased, albeit rare, risk of venous thromboembolism across several placebo-controlled trials and an increased risk of fatal stroke in one placebo-controlled trial in postmenopausal woman at increased risk for major coronary events. However, raloxifene was associated with a lower risk of venous thromboembolic events and cataracts than tamoxifen in a head-to-head trial. The choice of chemoprevention agent must consider a risk-benefit assessment for each individual patient. In this context, raloxifene is a valuable option for the prevention of invasive breast cancer in postmenopausal women with osteoporosis or at high risk of invasive breast cancer.
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Affiliation(s)
- Marit D Moen
- Wolters Kluwer Health
- Adis, Auckland, New Zealand.
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Abstract
Breast cancer risk factors have been studied for the past three decades, and the single most important risk factor is age. Hormonally linked adult reproductive and anthropometric risk factors contribute to the etiology of postmenopausal breast cancer. The risk of breast cancer increases among women older than 50 years of age who have benign breast disease, especially those with atypical ductal or lobular hyperplasia. Lobular carcinoma in situ increases risk significantly, as do a family history of breast cancer in first-degree relatives and the presence of BRCA1 or BRCA2 mutations. Diet, exercise, and environmental factors play a very small role in overall risk. Mammographic breast density increases relative risk fivefold among women with the highest density, and breast cancer risk is two to three times greater in women with elevated serum levels of estradiol or testosterone. Multivariate risk models allow determination of composite relative risks and cumulative lifetime risk, although improved models for African American women are required. For postmenopausal women, newer risk models are being developed and validated that include age, breast density, race, ethnicity, family history of breast cancer, a previous breast biopsy, body mass index, age at onset of natural menopause, hormone therapy, and previous false-positive mammography. A simpler model that includes only age, breast cancer in first-degree relatives, and previous breast biopsy performs well for estrogen receptor-positive breast cancer in postmenopausal women. As many as 10 million women in the United States are at increased risk, and clinicians are obligated to identify these women and manage their risk appropriately.
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Abstract
Exposure to higher levels of both exogenous and endogenous hormone is associated with breast cancer risk. Because of the association between breast cancer and HRT, only the minimal duration of HRT use is recommended for symptom control, and it is not recommended for chronic disease management. Current research issues include the role of progestins, other types of HRT, duration of unopposed estrogen use, and characteristics of cancers that develop on HRT. Circulating sex steroid levels are associated with breast cancer risk, but multiple issues need to be addressed before they are used routinely in clinical practice. Current research issues include measurement of levels for routine clinical practice, integration with standard breast cancer risk models and genetic polymorphism data, and applicability to estrogen-receptor-negative cancers.
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Affiliation(s)
- Wendy Y Chen
- Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Avenue, Harvard Medical School, Boston, MA 02115, USA.
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Lee WL, Chao HT, Cheng MH, Wang PH. Rationale for using raloxifene to prevent both osteoporosis and breast cancer in postmenopausal women. Maturitas 2008; 60:92-107. [PMID: 18534794 DOI: 10.1016/j.maturitas.2008.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 04/05/2008] [Accepted: 04/14/2008] [Indexed: 11/27/2022]
Abstract
Both osteoporosis with fracture and breast cancer are important health issues for postmenopausal women. It is well known that estrogen and estrogen receptors (ERs) play an important role in the pathogenesis of both diseases. In past decades, hormone therapy (HT), mainly estrogen plus progestin (EPT), has been frequently used for the purpose of preventing and treating postmenopausal osteoporosis because of its efficacy, but it also contributes to a significant increase in breast cancer. Currently, there is a dilemma regarding the use of estrogen for postmenopausal women. Fortunately, an increasing understanding of the action of estrogen has led ultimately to the design of new drugs that work by virtue of their interaction with the ER; these drugs have come to be known as selective estrogen receptor modulators (SERMs), and are not only effective in preventing osteoporosis and managing those with osteoporosis, but also in decreasing the incidence of breast cancer. Among these SERMs, raloxifene may be the most attractive agent based on the evidence from five recent large trials (Multiple Outcomes of Raloxifene Evaluation [MORE], Continuing Outcomes Relevant to Evista [CORE], Raloxifene Use for the Heart [RUTH], Study of Tamoxifen and Raloxifene [STAR], and Evista Versus Alendronate [EVA]). The former three trials showed that raloxifene not only decreases the incidence of osteoporosis-associated fractures, but also has efficacy in breast cancer prevention. The head-to-head comparison with the anti-fracture agent alendronate (EVA trial) and the chemoprevention agent tamoxifen (STAR trial) further confirmed that raloxifene is a better choice. We concluded that since there is an absence of a therapeutic effect on relieving climacteric symptoms and there is the presence of a potential risk of thromboembolism in the use of raloxifene, this drug can be prescribed for clear indications, such as the management of osteoporosis, the prevention of fracture, and decreasing the incidence of invasive breast cancer, with careful monitoring for thromboembolism. It is reasonable to use raloxifene as an appropriate medicine that targets climacteric symptom-free postmenopausal women because of its overall favorable risk-benefit safety profile using the global index proposed by the Women's Health Initiation (WHI).
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Affiliation(s)
- Wen-Ling Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Chen Hsin Rehabilitation Center-Taipei, Taiwan
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Kallio A, Zheng A, Dahllund J, Heiskanen KM, Härkönen P. Role of mitochondria in tamoxifen-induced rapid death of MCF-7 breast cancer cells. Apoptosis 2008; 10:1395-410. [PMID: 16215679 DOI: 10.1007/s10495-005-2137-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tamoxifen (Tam) is widely used in chemotherapy of estrogen receptor-positive breast cancer. It inhibits proliferation and induces apoptosis of breast cancer cells by estrogen receptor-dependent modulation of gene expression, but recent reports have shown that Tam (especially at pharmacological concentrations) has also rapid nongenomic effects. Here we studied the mechanisms by which Tam exerts rapid effects on breast cancer cell viability. In serum-free medium 5-7 microM Tam induced death of MCF-7 and MDA-MB-231 cells in a time-dependent manner in less than 60 min. This was associated with release of mitochondrial cytochrome c, a decrease of mitochondrial membrane potential and an increase in production of reactive oxygen species (ROS). This suggests that disruption of mitochondrial function has a primary role in the acute death response of the cells. Accordingly, bongkrekic acid, an inhibitor of mitochondrial permeability transition, was able to protect MCF-7 cells against Tam. Rapid cell death induction by Tam was not associated with immediate activation of caspase-9 or cleavage of poly (ADP-ribose) polymerase. It was not blocked by the caspase inhibitor z-Val-Ala-Asp-fluoromethylketone either. Diphenylene ionodium (DPI), an inhibitor of NADPH oxidase, was able to prevent Tam-induced cell death but not cytochrome c release, which suggests that ROS act distal to cytochrome c. The pure antiestrogen ICI 182780 (1 microM) could partly oppose the effect of Tam in estrogen receptor positive MCF-7 cells, but not in estrogen receptor negative MDA-MB-231 cells. Pre-culturing MCF-7 cells in the absence of 17beta-estradiol (E(2)) or in the presence of a low Tam concentration (1 microM) made the cells even more susceptible to rapid death induction by 5 or 7 microM Tam. This effect was associated with decreased levels of the anti-apoptotic proteins Bcl-X(L) and Bcl-2. In conclusion, our results demonstrate induction of a rapid mitochondrial cell death program in breast cancer cells at pharmacological concentrations of Tam, which are achievable in tumor tissue of Tam-treated breast cancer patients. These mechanisms may contribute to the ability of Tam therapy to induce death of breast cancer cells.
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Affiliation(s)
- A Kallio
- Department of Anatomy and Medicity Research Laboratory, Institute of Biomedicine, University of Turku, Tykistökatu 6A, 20520 Turku, Finland.
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Abstract
Breast cancer is a devastating illness that affects tens of thousands of American women each year. Although no one can predict who will actually develop breast cancer, a number of risk factors have been found that allow clinicians to identify the women at highest risk. Recent research has focused on exploring options, such as chemoprevention, to prevent high-risk women from developing breast cancer. The selective estrogen receptor (ER) modulators (SERMs) were a logical choice for chemoprevention because of their well-known estrogen antagonist effects in the breast. Tamoxifen is the best studied of these agents and has been shown to reduce the incidence of all breast cancers by 38% and ER-positive tumors by 48%.(1) However, despite this large potential risk reduction, risk management with chemopreventive agents is still not routine. The primary deterrents are believed to be the significant adverse events associated with tamoxifen as well as a perceived decline in quality of life (QOL).(2-4) These concerns led researchers to consider other possible agents that would still be effective but would have fewer or more acceptable side effects than tamoxifen. Raloxifene was proposed as an alternative to tamoxifen based on its estrogen antagonist effects in the breast and its relative safety as an osteoporosis agent. In this article, we will review the trials that led to the emergence of both tamoxifen and raloxifene as chemopreventive agents and will then offer a management strategy for breast cancer prevention in the primary care setting.
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Affiliation(s)
- Jennifer G Reeder
- Division of Hematology/Oncology, University of Pittsburgh Medical Center Cancer Pavilion, PA 15232, USA.
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The Role of Selective Estrogen Receptor Modulators on Breast Cancer: From Tamoxifen to Raloxifene. Taiwan J Obstet Gynecol 2008; 47:24-31. [DOI: 10.1016/s1028-4559(08)60051-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Traina TA, Poggesi I, Robson M, Asnis A, Duncan BA, Heerdt A, Dang C, Lake D, Moasser M, Panageas K, Borgen P, Norton L, Hudis C, Dickler MN. Pharmacokinetics and tolerability of exemestane in combination with raloxifene in postmenopausal women with a history of breast cancer. Breast Cancer Res Treat 2007; 111:377-88. [PMID: 17952589 DOI: 10.1007/s10549-007-9787-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 10/05/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE Raloxifene is a second-generation selective estrogen receptor modulator that reduces the incidence of breast cancer in postmenopausal women. Exemestane, a steroidal aromatase inhibitor, decreases contralateral new breast cancers in postmenopausal women when taken in the adjuvant setting. Preclinical evidence suggests a rationale for coadministration of these agents to achieve complete estrogen blockade. EXPERIMENTAL DESIGN We tested the safety and tolerability of combination exemestane and raloxifene in 11 postmenopausal women with a history of hormone receptor-negative breast cancer. Patients were randomized to either raloxifene (60 mg PO daily) or exemestane (25 mg PO daily) for 2 weeks. Patients then initiated combination therapy at the same dose levels for a minimum of 1 year. Pharmacokinetic and pharmacodynamic data for plasma estrogens, raloxifene, exemestane, and their metabolites were collected at the end of single-agent therapy and during combination therapy. RESULTS Plasma concentration-time profiles for each drug were unchanged with monotherapy versus combination therapy. Raloxifene did not affect plasma estrogen levels. Plasma estrogen concentrations were suppressed below the lower limit of detection by exemestane as monotherapy and when administered in combination with raloxifene. The most common adverse events of any grade included arthralgias, hot flashes, vaginal dryness and myalgias. CONCLUSIONS In this small study, coadministration of raloxifene and exemestane did not affect the pharmacokinetics or pharmacodynamics of either agent to a significant degree in postmenopausal women. The combination of estrogen receptor blockade and suppression of estrogen synthesis is well tolerated and warrants further investigation.
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Affiliation(s)
- T A Traina
- Memorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, New York, NY 10021, USA
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Prodhomme EJF, Ensch C, Bouche FB, Kaminski T, Deroo S, Seck P, Kirsch G, Muller CP. Synthesis of 4-[2-Aminoethyl(nitrosamino)]-1-pyridin-3-yl-butan-1-one, a New NNK Hapten for the Induction of N-Nitrosamine-Specific Antibodies. Bioconjug Chem 2007; 18:2045-53. [DOI: 10.1021/bc070046i] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanuel J. F. Prodhomme
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Corinne Ensch
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Fabienne B. Bouche
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Thomas Kaminski
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Sabrina Deroo
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Pierre Seck
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Gilbert Kirsch
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Claude P. Muller
- Institute of Immunology, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1011 Luxembourg, Luxembourg, LIMBP, University Paul Verlaine - Metz, 1 boulevard Arago, F-57070 Metz, France, Laboratoire de Rétrovirologie, CRP-Santé, 84 rue Val Fleuri, L-1526 Luxembourg, Luxembourg, and University of Luxembourg, 162A avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
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Abstract
Building upon the resources of traditional epidemiology, molecular epidemiology has extended our understanding that disease risk varies based not only upon acquired factors (e.g., exposures, behaviors, demographics), but also as a function of inherited factors (e.g., genetic polymorphisms). Individual susceptibility to cancer is influenced by polymorphisms in phase I enzymes (e.g., activation), phase 2 enzymes (e.g., detoxification), defects in the repair of DNA damage and other cancer susceptibility genes. Because tobacco use and nutrition represent behaviors/exposures which account for a significant number of cancer cases and deaths, these two factors are used to illustrate the relationship between genetic polymorphisms and disease prevention. Susceptibility to the health risks of smoking appears to be influenced by genetic factors that impact initiation, dependence, and nicotine metabolism. Nutrient metabolism also involves polymorphic enzyme pathways and gene-nutrient interactions may influence cancer risk. While the discipline of molecular epidemiology continues to face methodologic challenges related to the need to study large numbers of subjects, current knowledge can be applied to prevention activities. Genetic polymorphisms, and other molecular markers, can be used to develop clinical prevention studies targeted to unique subsets of persons at the highest risk of developing disease. Knowledge about the relationships between polymorphisms and disease outcomes can also be used for reinforcing healthy lifestyles, motivating positive behavior changes, helping to target medical therapy, and aiding in better focusing surveillance activities.
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Affiliation(s)
- Martin C Mahoney
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Kennecke HF, Olivotto IA, Speers C, Norris B, Chia SK, Bryce C, Gelmon KA. Late risk of relapse and mortality among postmenopausal women with estrogen responsive early breast cancer after 5 years of tamoxifen. Ann Oncol 2007; 18:45-51. [PMID: 17030545 DOI: 10.1093/annonc/mdl334] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Letrozole after 5 years of adjuvant tamoxifen results in a significant reduction in risk of recurrence from estrogen receptor (ER) positive breast cancer. An individualized estimate of the risk of relapse and death after 5 years of tamoxifen could improve decisions regarding extended hormonal therapy. METHODS The British Columbia Breast Cancer Outcomes database was used to identify women aged 45 years or older at the time of diagnosis with early-stage (I-IIIA) breast cancer who received tamoxifen and were disease free 5 years after diagnosis. Ten-year breast cancer event rates and mortality were calculated as well as annualized hazard rates of recurrence. RESULTS A total of 1086 women were identified with a median age of 64 years and follow-up of 10.5 years. The relative risk (RR) of death was 3.1 (P=0.003) and for recurrence was 1.7 (P=0.037) for N1 (one to three positive nodes) versus N0 (zero nodes positive) disease. N2 (four to nine nodes positive) had a RR of 5.8 (P<0.001) for death and 3.0 (P=0.002) for recurrence. Low tumor grade and high ER level subgroups had a more favorable prognosis. Annual breast cancer risk between years 6 and 10 was, respectively, 2.2%, 3.5% and 7.6% for N0, N1 and N2 disease and 2.6% and 4.5% for T1 and T2 breast cancer. CONCLUSION T and N stages predicted late relapse and death from breast cancer in a population-based cohort of postmenopausal women. Risk estimates reported herein may be used to optimize decision making regarding adjuvant therapy after 5 years of tamoxifen.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Aromatase Inhibitors/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- British Columbia
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/mortality
- Chemotherapy, Adjuvant
- Female
- Humans
- Letrozole
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/mortality
- Neoplasm Staging
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/mortality
- Nitriles/therapeutic use
- Postmenopause
- Prognosis
- Risk Factors
- Survival Rate
- Tamoxifen/therapeutic use
- Triazoles/therapeutic use
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Affiliation(s)
- H F Kennecke
- Division of Medical Oncology, British Columbia (BC) Cancer Agency; Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit.
| | - I A Olivotto
- Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit; Population and Preventive Oncology Programs; Victoria
| | - C Speers
- Breast Cancer Outcomes Unit; Population and Preventive Oncology Programs
| | - B Norris
- Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit; Fraser Valley, BC Cancer Agency, Canada
| | - S K Chia
- Division of Medical Oncology, British Columbia (BC) Cancer Agency; Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit
| | - C Bryce
- Division of Medical Oncology, British Columbia (BC) Cancer Agency; Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit
| | - K A Gelmon
- Division of Medical Oncology, British Columbia (BC) Cancer Agency; Department of Medicine, University of British Columbia, Vancouver, BC; Breast Cancer Outcomes Unit
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Abstract
Breast cancer is the most common cancer and the second most common cause of cancer death among women in the United States. While nonrandomized studies have reported that prophylactic mastectomy or oophorectomy can significantly reduce the risk of breast cancer, these approaches are unacceptable to the majority of women. Chemoprevention, which is defined as the prevention of cancer by pharmacological agents that inhibit or reverse the process of carcinogenesis, has thus increasingly become the focus of breast cancer prevention efforts. The first-generation selective estrogen receptor modulator (SERM) tamoxifen is the only US Food and Drug Administration- approved drug for breast cancer prevention and reduces the risk of breast cancer by as much as 50% in high-risk women. Raloxifene, a second-generation SERM, also has demonstrated efficacy for breast cancer prevention and is being compared with tamoxifen in a large randomized trial that has recently completed accrual. The aromatase inhibitors (AIs) decrease the incidence of contralateral breast cancer when used in the adjuvant setting and are being evaluated in ongoing primary prevention studies. In addition, a number of novel agents, including antiinflammatory drugs and retinoid derivatives, which appear to be of promise based on preclinical and epidemiological data, are under investigation. Several important challenges remain, including determination of the appropriate dose and duration of treatment when used in the primary prevention setting and development of new research models using surrogate end points for breast cancer incidence and mortality to permit more rapid clinical application of promising new agents.
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Affiliation(s)
- Ting Bao
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231-1000, USA
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