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Markopoulos C, Tzorakoleftherakis E, Polychronis A, Venizelos V, Xepapadakis G, Kalogerakos K, Papadiamantis J, Zobolas V, Janinis J, Dafni U. Management of bone loss in breast cancer patients: 24-month results from the ARBI trial of anastrozole with risedronate. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
552 Background: The management of bone mineral density (BMD) in postmenopausal, breast cancer (BC) patients (pts) receiveing anastrozole was investigated in this phase III, multicenter, open label trial. Methods: Pretreatment BMD of 217 eligible pts with hormone receptor-positive BC scheduled to receive anastrozole was evaluated at lumbar spine (LS) and hip (HP). Pts with T-score<-2.0 in LS or HP, received anastrozole 1mg/day plus oral risedronate 35 mg/week (A+R) and pts with T-score>-1 in both sites received anastrozole only (A). Pts with T-score<-1 in either site but T-score>-2.0 in both sites were randomized to receive A+R or A alone. All pts received Calcium and Vit D daily. BMD was then assessed at 12 and 24 months. Results: Comparison of randomized arms (A = 33 pts, A+R = 37 pts): T-score change from baseline was significantly different only for LS at 24 months (-0.23 in A vs 0.41 in A+R, Wilcoxon test p = 0.007) and was significantly higher from baseline for the A+R arm (Signed rank test p = 0.01). At 12 months, among A only pts, 4 (12.1%) had a T-score<-2.0 without becoming osteoporotic, while 2(6.1%) moved to the normal BMD region; from A+R pts, only 2(5.4%) had a T-score<-2.0 without becoming osteoporotic, while 9 (24.3%) moved to the normal BMD region. The same trend in BMD changes was also observed at the 24 month evaluation. Group with T-score<-2.0 in either LS or HP (A+R, n = 99): a significant increase for LS both at 12 and 24 months was detected (median increase of T-score by 0.45 and 0.37, p<0.01 for both time points) with a corresponding non-significant change in HP (p = 0.91 and p = 0.15). BMD in 13(13.3%) pts improved to the osteopenic region (-2.0<T-score<-1.0). Group with T-score>-1 in both sites (A, n = 48): significant decrease was detected for HP and LS, both at 12 and 24 months; however, only 11 (22%) pts became osteopenic and 1(2%) became osteoporotic. Conclusions: The addition of oral risedronate in postmenopausal BC patients with osteopenia receiving anastrozole has a favourable effect in BMD at lumbar spine at 24 months. [Table: see text]
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Affiliation(s)
- C. Markopoulos
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - E. Tzorakoleftherakis
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - A. Polychronis
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - V. Venizelos
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - G. Xepapadakis
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - K. Kalogerakos
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - J. Papadiamantis
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - V. Zobolas
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - J. Janinis
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
| | - U. Dafni
- Medical School, University of Athens, Athens, Greece; Medical School, University of Patra, Patra, Greece; 6th IKA, Athens, Greece; Euroclinic of Athens, Athens, Greece; IASO Hospital, Athens, Greece; Metaxa Anticancer Hospital, Athens, Greece; E. Benizelou Hospital, Athens, Greece; Agios Savas Anticancer Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; University of Athens, Athens, Greece
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Koumoundourou DS, Kassimatis TI, Tzorakoleftherakis E. Evaluation of Smad2/3 and Smad4 as inhibitors of estrogens and Ski protein as a predictive factor in T1, T2 N0 breast carcinomas. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1543 Background: Smad proteins are TGF-β intracellular substrates, and Ski protein is a negative regulator of TGF-pathway. Tamoxifen's inhibition in breast cancer cells is mediated through TGF-β and Smad proteins. The purpose of our study was to investigate the activation of Smad2/3, Smad4, and Ski proteins in breast carcinomas and correlate their expression with each other and with hormonal receptors, as well as with other clinicopathological parameters such as the tumor size and grade, and the Distant Disease Free and the Overall Survival. Methods: One hundred forty-seven paraffin-embedded specimens from 22 in situ and 125 invasive ductal node-negative carcinomas were used, for which we had a mean follow-up time of 96 months. ER and PR status, as well as the expression of Smad2/3, Smad4, and Ski proteins were evaluated using immunohistochemistry. Staining of 5% of the tumor cells was adopted as a threshold. SPSS13 for windows was used for the statistical analysis of the results. Results: Smad2/3 and Smad4 were strongly correlated with each other (p < 0,001) and inversely correlated with patients’ DDFS (Kaplan-Meier plots, p = 0,004 for Smad2/3 and p = 0,026 for Smad4) and OS (Kaplan-Meier plots, p = 0,034 for Smad2/3 and p = 0,017 for Smad4). Smad2/3 was proved to be an independent prognostic factor in grade 1 tumors, while Smad4 was inversely correlated with PR expression (p = 0,028) and had a strong prognostic value in ER+ tumors (p = 0,02). Ski protein had a strong association with tumor grade (p < 0.001) and was found to be an independent prognostic factor in Cox regression analysis (p = 0,006, exp(B) = 4,98). Conclusions: Smad 2/3 and Smad 4 not only are tumor suppressor molecules, but also inhibit ER dependent gene expression. This inhibition is lost when Smad's expression is reduced, and that is a potent explanation for Smad 4 prognostic value in ER positive tumors. Moreover the correlation with PR expression, may be due to the fact that PR is an indicator of ER pathway's integrity and also to PR's enallaktiki activation by ER-β. From the other hand, Ski protein acts as an oncogene in breast carcinogenesis and contributes to the development of a more aggressive tumor phenotype. No significant financial relationships to disclose.
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Affiliation(s)
- D. S. Koumoundourou
- University Hospital of Rio, Patras, Greece; University of Rio Patras, Rio, Patras, Greece
| | - T. I. Kassimatis
- University Hospital of Rio, Patras, Greece; University of Rio Patras, Rio, Patras, Greece
| | - E. Tzorakoleftherakis
- University Hospital of Rio, Patras, Greece; University of Rio Patras, Rio, Patras, Greece
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