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Hadji P, Stoetzer O, Decker T, Kurbacher CM, Marmé F, Schneeweiss A, Mundhenke C, Distelrath A, Fasching PA, Lux MP, Lüftner D, Janni W, Muth M, Kreuzeder J, Quiering C, Grischke EM, Tesch H. The impact of mammalian target of rapamycin inhibition on bone health in postmenopausal women with hormone receptor-positive advanced breast cancer receiving everolimus plus exemestane in the phase IIIb 4EVER trial. J Bone Oncol 2018; 14:010-10. [PMID: 30515367 PMCID: PMC6263089 DOI: 10.1016/j.jbo.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 01/31/2023] Open
Abstract
Background Breast cancer and its treatments are associated with a detrimental effect on bone health. Here we report the results of an exploratory analysis assessing changes in levels of biomarkers of bone metabolism in patients enrolled in the phase IIIb 4EVER study. Methods The 4EVER trial investigated everolimus in combination with exemestane in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative locally advanced or metastatic breast cancer. In this prespecified exploratory analysis, changes in biomarkers of bone turnover were assessed in patients from baseline to weeks 4, 12, and 24. The serum bone markers assessed were procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linking telopeptide of type 1 collagen (CTX), osteocalcin, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25-OH-vitamin D). On-treatment changes in bone markers over time were described per subgroup of interest and efficacy outcomes. Results Bone marker data were available for 241 of 299 enrolled patients. At the final assessment, P1NP, osteocalcin, PTH, 25-OH-vitamin D (all P < 0.001), and CTX (P = 0.036) were significantly decreased from baseline values per the Wilcoxon signed-rank test. At the last assessment (24 weeks or earlier), levels of serum CTX and PTH were significantly lower (P = 0.009 and P = 0.034, respectively) among patients with vs. without prior antiresorptive treatment (ART). Serum CTX levels were significantly lower (P < 0.001), and 25-OH-vitamin D concentrations significantly higher (P = 0.029), at the last postbaseline assessment in patients receiving concomitant ART vs. those without ART. Changes from baseline in PTH and 25-OH-vitamin D concentrations to the final assessment were significantly smaller in patients with prior ART. Lower baseline serum concentrations of osteocalcin and PTH were associated with clinical response (partial vs. non-response) at 24 weeks. High serum levels of CTX and P1NP at baseline were risk factors for progression at 12 weeks. Conclusions These exploratory analyses support use of everolimus plus exemestane for the treatment of postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer, and add to the body of evidence suggesting a potentially favorable impact of everolimus on bone turnover. Trial registration NCT01626222. Registered 22 June 2012, https://clinicaltrials.gov/ct2/show/NCT01626222.
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Key Words
- 25-OH-vitamin D, 25-hydroxyvitamin D
- Art, antiresorptive therapy
- BSAP, bone-specific alkaline phosphatase
- Bone health
- Bone marker
- Breast cancer
- CI, confidence interval
- CR, complete response
- CTX, C-terminal cross-linking telopeptide of type 1 collagen
- Everolimus
- HER2-negative, human epidermal growth factor receptor 2-negative
- HR, hazard ratio
- HR +, hormone receptor-positive
- Hormone receptor-positive
- Mammalian target of rapamycin
- NSAI, non-steroidal aromatase inhibitor
- OR, overall response
- ORR, overall response rate
- ORR24w, overall response rate within the first 24 weeks of treatment
- P1NP, procollagen type 1 N-terminal peptide
- PFS, progression-free survival
- PR, partial response
- PTH, parathyroid hormone
- SD, standard deviation
- SRE, skeletal-related event
- mTOR, mammalian target of rapamycin
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Affiliation(s)
- Peyman Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, North West Hospital, Steinbacher Hohl 2-26, 60488 Frankfurt am Main, Germany.,Philipps University of Marburg, Steinbacher Hohl 2-26, 60488 Marburg Frankfurt, Germany
| | - Oliver Stoetzer
- Haematology and Oncology, Outpatient Cancer Care Center, Munich, Germany
| | | | | | - Frederik Marmé
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christoph Mundhenke
- Department of Obstetrics and Gynecology, University Hospital Kiel, Kiel, Germany
| | - Andrea Distelrath
- Praxisgemeinschaft für Onkologie und Urologie, Facharztzentrum am Meer, Friedrich-Paffrath-Str. 98, 26389 Wilhelmshaven, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Diana Lüftner
- Medical Department for Haematology, Oncology, and Tumor Immunology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | | | | | | | - Eva-Marie Grischke
- Department of Obstetrics and Gynecology, University of Tuebingen, Germany
| | - Hans Tesch
- Department of Oncology, Bethanien Hospital, Frankfurt am Main, Germany
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