Objective
Concerns about increased breast cancer risk with estrogen and progestin therapy have led to an increased interest in progestin alternatives. The main objective of this study was to determine if bazedoxifene acetate (BZA), a new selective estrogen receptor modulator (SERM), would antagonize the proliferative and transcriptional effects of conjugated equine estrogens (CEE) in the breast.
Methods
As part of a 20 month preclinical trial, ninety-five ovariectomized cynomolgus macaques (Macaca fascicularis) were randomized to receive no treatment or treatment with BZA (20 mg/d), CEE (0.45 mg/d), or BZA and CEE in combination (women’s daily equivalent doses). Data presented here include breast effects following 6 months of treatment. Endpoints included histomorphometry, histopathologic evaluations, gene microarray assays, PCR quantification of specific ERα activity markers, and immunohistochemical detection of sex steroid receptors, and the proliferation marker Ki67.
Results
BZA+CEE and BZA resulted in significantly less total epithelial density, lobular enlargement, and Ki67 immunolabeling in the terminal ducts compared to CEE alone (P < 0.05 for all). The addition of BZA to CEE antagonized the expression of ERα-regulated genes such as GREB1 and TFF1 (P < 0.01 for both), while BZA alone had minimal effects on ERα-mediated transcriptional activity. BZA and BZA+CEE did not significantly up-regulate genes related to cell cycle progression and proliferation. BZA with and without CEE also resulted in less lobular and terminal duct ERα immunolabeling compared to control and CEE (P < 0.0001 for all).
Conclusions
These findings demonstrate that BZA given at a clinically relevant dose is an estrogen antagonist in the breast, supporting the idea that CEE + BZA may provide a lower breast cancer risk profile compared to traditional estrogen + progestin therapies.