Lipid Changes During Endocrine Therapy in Breast Cancer Patients: The Results of a 5-Year Real-World Retrospective Analysis

Abstract

BackgroundThe aim of this study was to investigate the status of serum lipids during endocrine therapy.MethodsWe retrospectively analysed lipid profiles during the 5-year treatment of 1487 consecutive postoperative BC patients. Lipid parameters included triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C). Those biomarkers were measured at baseline and 1, 2, 3, 4 and 5 years following the initiation of endocrine therapy.ResultsFor premenopausal BC patients, LDL levels rapidly decreased at 1 year in the tamoxifen (TAM) group compared with baseline levels (p<0.05), and this decline remained for the following 4 years. Additionally, LDL levels were significantly lower in the TAM group than in the nonendocrine group at all assessment time points (p<0.05). Similarly, TC levels also decreased in the TAM group compared with baseline levels at all assessment time points (p<0.05), and compared with the levels in the nonendocrine group, TC levels were also lower for the first 4 years. For postmenopausal BC patients, there was no significant difference in the lipid profiles (TG, TC, LDL and HDL) in the letrozole (LET), anastrozole (ANA) or exemestane (EXE) groups compared with the nonendocrine group. For patients who received TAM, compared with the nonendocrine group, TC levels decreased at 1 year, and LDL levels decreased at 1 and 2 years.ConclusionsTAM may improve LDL and TC levels in premenopausal BC patients. In postmenopausal BC patients, aromatase inhibitors (AIs) may have no adverse effects on lipid profiles, and TAM may have limited beneficial effects on serum lipids.

Correlation between serum lipid levels and endocrine resistance in patients with ER-positive breast cancer

“…[ 24 ] However, in BC endocrine therapy, Tamoxifen reduced TC and LDL-C levels. [ 15 ] Tamoxifen binds to microsomal antiestrogen binding sites with high affinity and inhibits cholesterol esterification at therapeutic doses. [ 16 ] On the basis that ET is beneficial to controlling serum lipid levels, but lipid-related components are the factors driving endocrine resistance, we wanted to explore whether serum lipids have good predictive indicators for early screening of endocrine resistance.…”

“…[ 13 , 14 ] In BC endocrine therapy, Tamoxifen reduced total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels. [ 15 ] Tamoxifen binds with high affinity to the microsomal antiestrogen binding site and inhibits cholesterol esterification at therapeutic doses. [ 16 ] There have also been some reports of lipid metabolism involved in ET, lipid metabolism is involved in tamoxifen resistance and cholesterol metabolism plays a role in tamoxifen resistance.…”

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

“…Our nding of no association with dyslipidemia in pre-and postmenopausal tamoxifen users is generally consistent with the existing literature. Studies suggest favorable lipid pro les, including decreased total cholesterol and low-density lipoprotein cholesterol and increased high-density lipoprotein cholesterol, for tamoxifen users in both premenopausal and postmenopausal BC survivors [31][32][33][34][35][36][37][38][39][40][41][42]. In contrast, prior research frequently reports no signi cant changes in lipid pro les with AI use [19,34,35,41,43,44].…”

“…Studies suggest favorable lipid pro les, including decreased total cholesterol and low-density lipoprotein cholesterol and increased high-density lipoprotein cholesterol, for tamoxifen users in both premenopausal and postmenopausal BC survivors [31][32][33][34][35][36][37][38][39][40][41][42]. In contrast, prior research frequently reports no signi cant changes in lipid pro les with AI use [19,34,35,41,43,44]. Furthermore, studies investigating dyslipidemia as an outcome endpoint reported no association in BC survivors comparing AI to tamoxifen users [40,43].…”