Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids

Francini, Guido; Petrioli, Roberto; Montagnani, A; Cadirni, Alice; Campagna, S.; Francini, Edoardo; Gonnelli, Stefano

doi:10.1038/sj.bjc.6603258

Cited by 69 publications

(60 citation statements)

References 31 publications

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“…A study that compared women who were switched to exemestane after 2 years of tamoxifen with women who remained on tamoxifen found no significant weight change in the tamoxifen group at 12 months; however, they found weight loss in the exemestane group (p = 0.06) [53]. In the second study, women on an AI (AI type not specified) were 46 % less likely to experience C5 % increase in weight (AI OR 0.54, 95 % CI 0.31-0.93) compared to women on selective estrogen receptor modulator (SERM); also, greater than 5 % weight gain was reported by 56 % of women on SERM compared to 34 % on AI (p \ 0.01) [54].…”

Section: Tamoxifen and Aimentioning

confidence: 90%

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

Nyrop

Muss

et al. 2016

Breast Cancer Res Treat

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Most breast cancer (BC) tumors are early stage and hormone receptor positive, where treatment generally includes adjuvant endocrine treatment (ET). Oncology providers and women about to start ET want to know about side effects, including potential weight gain. The aim of this study was a literature review to identify the independent effect of ET on post-diagnosis weight gain. Weight gain is of concern with regard to potential associations with BC recurrence, mortality, and quality of life in survivorship. We conducted a targeted review of the literature. Thirty-eight studies met our inclusion criteria. Patient-reported weight gain ranged widely from 18 to 52 % of patients in Year 1 and from 7 to 55 % in Year 5. Some studies reported categories of weight change: lost weight (9-17 %), stable weight (47-64 %), and gained weight (27-36 %). Most studies comparing ET with placebo or tamoxifen with AI reported no significant difference between the two groups. Wide-ranging and inconsistent results point to the need for further research to clarify annual weight change (loss, gain, stability) from BC diagnosis through 5 years of ET and beyond. There is also a need to explore weight change by type of ET and to explore risk factors for weight gain in women on ET, including tumor type, sociodemographic characteristics, and health behaviors. More specific information is needed to identify high-risk BC patients who could be targeted for weight management interventions.

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Section: Tamoxifen and Aimentioning

confidence: 90%

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

Nyrop

Muss

et al. 2016

Breast Cancer Res Treat

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“…The first report of the ATAC trial suggested no difference in weight gain between tamoxifen and anastrozole [20]. Furthermore, Francini et al [21] reported no significant weight change with exemestane when given after 2 years of tamoxifen in postmenopausal women with early breast cancer.…”

Section: Introductionmentioning

confidence: 97%

Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer

Šestak

Harvie

Howell

et al. 2012

Breast Cancer Res Treat

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Weight gain is commonly reported by breast cancer patients on tamoxifen or aromatase inhibitors. Since weight gain may impact on outcome and compliance we have prospectively assessed the effects of these agents on weight change in three randomised trials for the treatment or prevention of breast cancer. Data on weight change in postmenopausal women from three large clinical trials investigating endocrine therapy for the treatment or prevention of breast cancer were analysed (ATAC, IBIS-I and IBIS-II). In the IBIS-I study, mean weight change on tamoxifen was +0.1 kg (SD 0.1) compared with +0.3 kg (SD 0.1) in women taking the placebo (P = 0.3) between baseline and 12 months of follow-up. In the IBIS-II trial, no statistically significant difference was found between anastrozole and placebo after 12 months of follow-up [+0.8 kg (SD 5.3) vs. +0.5 kg (SD 7.4), P = 0.5]. In the ATAC trial, no statistically significant differences in weight gain between anastrozole and tamoxifen were found after 12 months of follow-up [+1.4 kg (SD 3.9) vs. +1.5 kg (SD 4.0), P = 0.4]. Significant baseline predictors for gaining more than 5 kg of weight after 12 months of follow-up were: being younger than 60 years old, smoking and mastectomy. All three trials demonstrate that weight gain occurs primarily within the first 12 months of active treatment in a subset of patients. In the prevention trials, weight gain does not differ between anastrozole, tamoxifen and placebo and also did not differ between anastrozole and tamoxifen in the treatment trial.

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“…However, the patients receiving exemestane after TMX had a significant reduction in FM and a higher FFM/FM ratio at the 12-month follow-up. These findings suggest that exemestane may affect FM [37]. …”

Section: Discussionmentioning

confidence: 99%

The Effects of Adjuvant Endocrine Treatment on Serum Leptin, Serum Adiponectin and Body Composition in Patients with Breast Cancer: The Izmir Oncology Group (IZOG) Study

Akyol¹,

Demir²,

Alacacıoğlu³

et al. 2015

Chemotherapy

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Background: A limited number of studies have been conducted on the effects of hormonal therapy with tamoxifen (TMX) or aromatase inhibitors (AIs) on plasma levels of leptin and adiponectin, as well as body composition in breast cancer (BC) patients. Therefore, we aimed to analyze the relationship between adipocytokines and body composition as well as the effects of TMX and AIs on plasma adiponectin, leptin, leptin/adiponectin ratio (LAR) and body composition. Methods: Patients were treated with either TMX or AI according to their menopausal status after adjuvant radiotherapy. Changes in body composition and serum leptin and adiponectin levels were evaluated. We recorded the type of hormonal therapy, BMI, waist/hip ratio (WHR), leptin and adiponectin levels at study entry, and after 6 and 12 months. Results: From baseline to the 6- and 12-month follow-ups, there were statistically significant increases in WHR (p = 0.003), fat mass (p = 0.041), and serum leptin (p < 0.001) and adiponectin levels (p < 0.001). The changes in body composition and serum leptin and adiponectin levels were similar in TMX and AI groups. A statistically significant decrease was found in total body water and LAR (p < 0.001). Although weight and body fat percentage increased, such increases were not statistically significant. A positive correlation was found between baseline BMI and serum leptin levels. This correlation was maintained at 6 and 12 months. The negative correlation found between serum adiponectin levels at baseline and baseline BMI did not last throughout the study. Conclusion: In this study, increased leptin and adiponectin levels and a decreased LAR were found in both AI and TMX groups. These changes might have occurred through both mechanisms of hormonal therapy and body composition changes. Therefore, AIs and TMX may exert their protective effects for BC patients by decreasing LAR rather than affecting leptin or adiponectin alone.

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Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids

Cited by 69 publications

References 31 publications

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

Weight gain during adjuvant endocrine treatment for early-stage breast cancer: What is the evidence?

Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer

The Effects of Adjuvant Endocrine Treatment on Serum Leptin, Serum Adiponectin and Body Composition in Patients with Breast Cancer: The Izmir Oncology Group (IZOG) Study

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