Lipid changes in breast cancer patients on exemestane treatment: final results of the TEAM Greek substudy

Markopoulos, Christos; Polychronis, A.; Dafni, Urania; Koukouras, D.; Zobolas, V.; Tzorakoleftherakis, E.; Xepapadakis, Grigorios; Gogas, Helen

doi:10.1093/annonc/mdn545

Cited by 35 publications

(21 citation statements)

References 42 publications

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“…However, in the Greek substudy, exemestane had a neutral effect on the lipid profile during the first 24 months 46. Although total cholesterol decreased from baseline in both groups, the decrease only became significantly different from that in the tamoxifen group during months 18 to 24 ( P ≤ 0.02).…”

Section: Safety and Side Effectsmentioning

confidence: 79%

Exemestane in the Adjuvant Treatment of Breast Cancer in Postmenopausal Women

Kittaneh

Glück

2011

Breast Cancer�(Auckl)

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Exemestane is an irreversible inhibitor of the aromatase enzyme, which is a key component in the production of estrogen. The majority of breast cancers are sensitive to the proliferative effects of estrogen. Exemestane is approved for the adjuvant treatment of postmenopausal women with breast cancer after 2 to 3 years of tamoxifen therapy, based on a 32% improvement in disease-free survival compared with 5 years of tamoxifen alone (P < 0.001). Exemestane has also shown clinical benefits as an upfront therapy. The safety profile of exemestane shares some side effects with tamoxifen (hot flashes and arthralgia), but is not associated with an increased risk of endometrial cancer or thromboembolic events. This review will discuss in detail the efficacy and safety of exemestane in early breast cancer.

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Section: Safety and Side Effectsmentioning

confidence: 79%

Exemestane in the Adjuvant Treatment of Breast Cancer in Postmenopausal Women

Kittaneh

Glück

2011

Breast Cancer�(Auckl)

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“…10–12 In 2 conflicting reports, a largely neutral effect of exemestane on the lipidemic profile was demonstrated. 13–15 As is the case for exemestane, clinical trials investigating lipid effects of the nonsteroidal AI letrozole also have divergent findings. In an early study, letrozole treatment was shown to significantly increase total and LDL cholesterol.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Changes in the Lipid Profile of Postmenopausal Women With Early Stage Breast Cancer Treated With Exemestane or Letrozole

Bell

Nguyen

et al. 2012

The Journal of Clinical Pharma

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Effects of aromatase inhibitor (AI) therapy on the plasma lipid profile are not clear. Here the authors describe changes in fasting lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) before and after 3 months of exemestane or letrozole treatment. HDL was reduced in the entire cohort (P < .001) and in the exemestane group (P < .001) but unchanged in the letrozole group (P = .169). LDL was increased in the entire cohort (P = .005) and in the letrozole group (P = .002) but unchanged in the exemestane group (P = .361). This effect was at least partially attributable to washout of tamoxifen as only patients with prior use of tamoxifen experienced a significant increase in LDL. Baseline HDL was an independent predictor of the change in HDL (r2 = −0.128, P < .001), and prior tamoxifen use was associated with greater increases in LDL (r2 = 0.057, P < .001). Use of lipid-altering medications did not protect against the exemestane-induced drop in HDL or the increase in LDL observed in women with prior use of tamoxifen taking letrozole. In conclusion, AI treatment and/or washout of tamoxifen induced detrimental changes in the lipid profile of postmenopausal women with breast cancer.

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“…The ATENA trial evaluated the effect of extending adjuvant therapy with exemestane for 2 years after completion of 5 years of tamoxifen treatment. This extended regimen did not induce significant effects on lipid profiles during the 24 months of the study (Markopoulos et al 2009b). Consequently, data from both trials were reassuring.…”

Section: Lipid Metabolismmentioning

confidence: 86%

Aromatase inhibitors in the breast cancer clinic: focus on exemestane

Asten¹,

Neven²,

Lintermans³

et al. 2014

Endocrine-Related Cancer

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Breast cancer is the most prevalent type of cancer in women and responsible for significant female cancer-related mortality worldwide. In the Western world, over 80% of breast cancers are hormone-receptor positive for which endocrine therapy is administered. The main anti-estrogen treatments in use consist of selective estrogen-receptor modulators, such as tamoxifen, and third-generation aromatase inhibitors (AIs), such as exemestane, letrozole, and anastrozole. In this review, the focus will lie on exemestane, its clinical use, and its side-effect profile. Exemestane is the only third-generation steroidal AI. Its efficacy as a first-line treatment in metastatic breast cancer has been demonstrated. Therefore, exemestane could be considered a valid first-line therapeutic option, but it also can be used in second-line or further situations. Exemestane is mostly used as part of sequential adjuvant treatment following tamoxifen, but in this setting it is also active in monotherapy. Furthermore, this AI has been studied in the neoadjuvant setting as presurgical treatment, and even as chemoprevention in high-risk healthy postmenopausal women. It may reverse side effects of tamoxifen, such as endometrial changes and thromboembolic disease but may also cause some inconvenient side effects itself. Additionally, there is a lack of total crossresistance between exemestane and nonsteroidal AIs as far as their anti-tumoral efficacy is concerned; moreover the two classes of AIs display a nontotal overlapping toxicity profile. Taking together, exemestane can be considered as a useful treatment option at all stages of breast cancer.

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Lipid changes in breast cancer patients on exemestane treatment: final results of the TEAM Greek substudy

Cited by 35 publications

References 42 publications

Exemestane in the Adjuvant Treatment of Breast Cancer in Postmenopausal Women

Exemestane in the Adjuvant Treatment of Breast Cancer in Postmenopausal Women

Comparison of Changes in the Lipid Profile of Postmenopausal Women With Early Stage Breast Cancer Treated With Exemestane or Letrozole

Aromatase inhibitors in the breast cancer clinic: focus on exemestane

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