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Nuzzo F, Gallo C, Lastoria S, Di Maio M, Piccirillo MC, Gravina A, Landi G, Rossi E, Pacilio C, Labonia V, Di Rella F, Bartiromo A, Buonfanti G, De Feo G, Esposito G, D'Aniello R, Maiolino P, Signoriello S, De Maio E, Tinessa V, Colantuoni G, De Laurentiis M, D'Aiuto M, Di Bonito M, Botti G, Giordano P, Daniele G, Morabito A, Normanno N, de Matteis A, Perrone F. Bone effect of adjuvant tamoxifen, letrozole or letrozole plus zoledronic acid in early-stage breast cancer: the randomized phase 3 HOBOE study. Ann Oncol 2012; 23:2027-2033. [PMID: 22412041 DOI: 10.1093/annonc/mdr600] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To measure bone mineral density (BMD) reduction produced by letrozole as compared with tamoxifen and the benefit of the addition of zoledronic acid. PATIENTS AND METHODS A phase 3 trial comparing tamoxifen, letrozole or letrozole+zoledronic acid in patients with hormone receptor-positive early breast cancer was conducted; triptorelin was given to premenopausal patients. Two comparisons were planned: letrozole versus tamoxifen and letrozole+zoledronic acid versus letrozole. Primary end point was the difference in 1-year change of T-score at lumbar spine (LTS) measured by dual energy X-ray absorptiometry scan. RESULTS Out of 483 patients enrolled, 459 were available for primary analyses. Median age was 50 (range 28-80). The estimated mean difference (95% confidence interval [CI]) in 1-year change of LTS was equal to -0.30 (95% CI -0.44 to -0.17) in the letrozole versus tamoxifen comparison (P<0.0001) and to +0.60 (95% CI +0.46 to +0.77) in the letrozole+zoledronic acid versus letrozole comparison (P<0.0001). Bone damage by letrozole decreased with increasing baseline body mass index in premenopausal, but not postmenopausal, patients (interaction test P=0.004 and 0.47, respectively). CONCLUSIONS In the HOBOE (HOrmonal BOne Effects) trial, the positive effect of zoledronic acid on BMD largely counteracts damage produced by letrozole as compared with tamoxifen. Letrozole effect is lower among overweight/obese premenopausal patients.
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Affiliation(s)
- F Nuzzo
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - C Gallo
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli
| | - S Lastoria
- Nuclear Medicine and Metabolic Therapy, Department of Imaging, National Cancer Institute, Napoli
| | - M Di Maio
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - M C Piccirillo
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - A Gravina
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - G Landi
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - E Rossi
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli; Division of Medical Oncology, Department of Oncohematology, S. Giuseppe Moscati Hospital, Avellino
| | - C Pacilio
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - V Labonia
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - F Di Rella
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - A Bartiromo
- Nuclear Medicine and Metabolic Therapy, Department of Imaging, National Cancer Institute, Napoli
| | - G Buonfanti
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - G De Feo
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - G Esposito
- Laboratory Medicine, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - R D'Aniello
- Department of Pharmacy, National Cancer Institute, Napoli
| | - P Maiolino
- Department of Pharmacy, National Cancer Institute, Napoli
| | - S Signoriello
- Medical Statistics, Department of Medicine and Public Health, Second University, Napoli
| | - E De Maio
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - V Tinessa
- Division of Medical Oncology, Department of Oncology, Rummo Hospital, Benevento
| | - G Colantuoni
- Division of Medical Oncology, Department of Oncohematology, S. Giuseppe Moscati Hospital, Avellino
| | - M De Laurentiis
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - M D'Aiuto
- Division of Surgical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - M Di Bonito
- Pathology, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - G Botti
- Pathology, Department of Pathology and Laboratory Diagnostics, National Cancer Institute, Napoli
| | - P Giordano
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - G Daniele
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - A Morabito
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli
| | - N Normanno
- Cellular Biology and Biotherapy, Department of Research, National Cancer Institute, Napoli, Italy
| | - A de Matteis
- Medical Oncology, Department of Senology, National Cancer Institute, Napoli
| | - F Perrone
- Clinical Trials Unit, Department of Research, National Cancer Institute, Napoli.
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