The effect of exemestane, anastrozole, and tamoxifen on lipid profiles in Japanese postmenopausal early breast cancer patients: final results of National Surgical Adjuvant Study BC 04, the TEAM Japan sub-study

Hozumi, Yasuo; Suemasu, Kimito; Takei, Hiroyuki; Aihara, Tomohiko; Takehara, Megumi; Saito, Tsuyoshi; Ohsumi, Shozo; Masuda, Norikazu; Ohashi, Yasuo

doi:10.1093/annonc/mdq707

Cited by 49 publications

(44 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the targeted therapy trastuzumab has been associated with an increased risk of heart failure 16 , this agent was not available to treat BCS at the time this study was performed. Endocrine therapy with tamoxifen may reduce TC and LDL-C, while increasing TG levels 18 . A systematic review found that the use of aromatase inhibitors, compared with tamoxifen, was associated with increased odds of developing CVD and hypercholesterolemia 17 .…”

Section: Discussionmentioning

confidence: 99%

“…The addition of traditional risk factors for CVD to chemotherapy [13][14][15] , radiotherapy 14 , targeted therapy 16 and endocrine therapy 17 may increase CVD risk in BCS. Use of endocrine therapy may be associated with favorable or unfavorable alterations in lipid profile 17,18 . CVD risk may be assessed by algorithms or mathematical models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

Sousa-e-Silva¹,

Conde²,

Martinez³

et al. 2014

Rev. Bras. Ginecol. Obstet.

View full text Add to dashboard Cite

PURPOSE: It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS). METHODS:This cross-sectional study analyzed 67 BCS, aged 45-65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI). RESULTS: Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01-0.2) for populations at high risk for CVD. CONCLUSIONS: These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations. ResumoOBJETIVO: Avaliar o risco de doença cardiovascular (DCV) em mulheres com câncer de mama. MÉTODOS: Foi conduzido estudo de corte transversal, com 67 mulheres com câncer de mama, entre 45 e 65 anos, tratamento oncológico completo, não usuárias de terapia hormonal, tamoxifeno ou inibidores da aromatase nos últimos 6 meses. Foram avaliados o perfil lipídico e o risco de DCV. Para avaliar o risco de DCV, foram utilizados os modelos Framingham e Systematic COronary Risk Evaluation (SCORE). Para investigar a concordância entre os modelos de risco cardiovascular, foi calculado o coeficiente kappa com seu respectivo intervalo de confiança (IC) de 95%. RESULTADOS: A média de idade das participantes foi de 53,2±6,0 anos. A prevalência de obesidade, hipertensão e dislipidemia foi 25, 34 e 90%, respectivamente. A prevalência de dislipidemia foi 90%. As anormalidades mais comuns do perfil lipídico foram: alto colesterol total (70%), alto LDL-C (51%) e alto não HDL-C (48%). Baseado no escore de Framingham, 22% das mulheres com câncer de mama apresentaram alto risco de doença arterial coronariana. De acordo com o modelo SCORE, 100 e 93% das participantes apresentaram baixo risco de DCV fatal, considerando populações de baixo e alto risco de DCV, respectivamente. A concordância entre os modelos de Framingham e SCORE foi ruim (kappa: 0,1; IC95% 0,01-0,2), considerando populações de alto risco de DCV. CONCLUSÕES: Esses dados indicam a necessidade de incluir a avaliação do perfil lipídico e do risco de DCV na rotina de seguimento de mulheres com câncer de mama, sendo observadoo adequado controle dos níveis séricos de lipídios.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

Sousa-e-Silva¹,

Conde²,

Martinez³

et al. 2014

Rev. Bras. Ginecol. Obstet.

View full text Add to dashboard Cite

show abstract

“…Patients who received tamoxifen also had lower LDL levels at all time points (P .0001) and reduced lipoprotein parameters compared with patients who received anastrozole or exemestane. 34 Compared with anastrozole, exemestane was associated with significantly lower mean levels of cholesterol at 3 months and at 12 months (P .01 for both). 34 Mean triglyceride concentrations were significantly lower with exemestane compared with tamoxifen at all time points (P .0001) and compared with anastrozole at 3 months (P .01) and at 6 months (P .0001).…”

mentioning

confidence: 89%

“…34 Compared with anastrozole, exemestane was associated with significantly lower mean levels of cholesterol at 3 months and at 12 months (P .01 for both). 34 Mean triglyceride concentrations were significantly lower with exemestane compared with tamoxifen at all time points (P .0001) and compared with anastrozole at 3 months (P .01) and at 6 months (P .0001). 34 In the IES (N ¼ 4658), which assessed the impact of a switch to exemestane after 2 to 3 years of adjuvant tamoxifen, after 55.7 months of follow-up, hypercholesterolemia trended higher in the exemestane arm versus the tamoxifen arm (204 of 2320 patients [8.8%] vs 178 of 2338 patients [7.6%]; P ¼ .14), but the difference did not reach statistical significance (Table 2).…”

mentioning

confidence: 89%

A woman's heart

Ewer

Glück

2009

Cancer

View full text Add to dashboard Cite

Adjuvant therapy in postmenopausal women with breast cancer may contribute to the expression of underlying cardiovascular disease or expose the heart to additional toxicities. Tamoxifen remains an important component of endocrine therapy for breast cancer, although major clinical trials of the aromatase inhibitors (AIs) anastrozole, letrozole, and exemestane suggest that these agents are more effective and better tolerated alternatives to tamoxifen. The AIs inhibit the conversion of androgens to estrogen in postmenopausal women; consequently, their mechanism of action differs from that of tamoxifen. Accordingly, although it has been observed that tamoxifen has some favorable effects on cardiovascular risk, such as reducing total cholesterol levels, because of its partial estrogen‐agonist properties, no such effects exist for the AIs. Some studies, particularly those that compare the AIs with tamoxifen, have suggested a less favorable impact of adjuvant AI therapy on cardiovascular risk. Comorbid conditions, including cardiovascular disease, emerge as competing causes of death as women with breast cancer continue to live longer, and the potential impact of adjuvant therapies on cardiovascular risk becomes an increasingly important consideration for clinicians. Cancer 2009. © 2009 American Cancer Society.

show abstract

“…How adjuvant regimens containing ais compare with the strategy of tamoxifen for 10 years is also unknown. 68 reported that tamoxifen had a favourable effect on lipid profiles and might be preferred over exemestane and anastrozole (both of which had no clinically significant effect on serum lipids) for patients at high risk of cardiovascular events such as hyperlipidemia. Two additional publications (abstracts only) 100,101 emerging from big 1-98 and atac provide an indirect comparison of anastrozole and letrozole, suggesting that letrozole could be more effective than anastrozole in reducing early distant recurrence and mortality rates at 5 years.…”

Section: Individual Studies and Comparison With Earlier Reviews And Mmentioning

confidence: 99%

Adjuvant Endocrine Therapy for Early Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline

et al. 2015

View full text Add to dashboard Cite

was the basis for the 2014 pebc guideline on systemic therapy for early breast cancer. The review of the evidence for systemic endocrine therapy (adjuvant tamoxifen, aromatase inhibitors, and ovarian ablation and suppression) is presented here; the evidence for chemotherapy and her2-targeted treatment-and the final clinical practice recommendations-are presented separately in this supplement. KEY WORDSEarly breast cancer, hormonal therapy, endocrine therapy, hormone receptor-positive breast cancer, tamoxifen, aromatase inhibitors, ovarian ablation, ovarian suppression

show abstract

The effect of exemestane, anastrozole, and tamoxifen on lipid profiles in Japanese postmenopausal early breast cancer patients: final results of National Surgical Adjuvant Study BC 04, the TEAM Japan sub-study

Abstract: Changes of lipid profiles in Japanese postmenopausal women treated with tamoxifen were relatively favorable, while exemestane and anastrozole had no clinically significant effect on the serum lipids.

Cited by 49 publications

References 21 publications

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

A woman's heart

Adjuvant Endocrine Therapy for Early Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline

Contact Info

Product

Resources

About