The effect of exemestane on serum lipid profile in postmenopausal women with metastatic breast cancer: a companion study to EORTC Trial 10951, ‘Randomized phase II study in first line hormonal treatment for metastatic breast cancer with exemestane or tamoxifen in postmenopausal patients’

Abstract

Overall, exemestane has no detrimental effect on cholesterol levels and the atherogenic indices, which are well-known risk factors for coronary artery disease. In addition, it has a beneficial effect on TRG levels. These data, coupled with E's excellent efficacy and tolerability, support further exploration of its potential in the metastatic, adjuvant and chemopreventive setting.

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

“…The increase in LDL-C may therefore be at least partially explained by the loss of the positive action of tamoxifen. The decrease in HDL-C in the exemestane group is in line with previous studies, and may be explained by a direct action of exemestane and/or by the interruption of tamoxifen therapy (Atalay et al, 2004;Lonning et al, 2005;Markopoulos et al, 2005;Esteva and Hortobagyi, 2006). The Intergroup Exemestane Study found a trend toward more frequent myocardial infarction in patients treated with exemestane than in those treated with tamoxifen (Coombes et al, 2004).…”

“…Nevertheless, it has recently been suggested that women receiving aromatase inhibitors for breast cancer prevention may be at increased risk of cardiovascular diseases, because the oestrogen-lowering effects of such drugs may have adverse effects on blood lipids (Baum et al, 2003;Goss et al, 2003;Atalay et al, 2004;Esteva and Hortobagyi, 2006;Markopoulos et al, 2005). Our data showed a significant increase in LDL-C in the patients treated with exemestane: this finding may seem to differ from those of other studies indicating that exemestane has a neutral effect on LDL-C, but it must be remembered that our patients had been treated with tamoxifen for at least 2 years, which markedly reduces LDL-C levels (Love et al, 1990;Atalay et al, 2004;Esteva and Hortobagyi, 2006;Markopoulos et al, 2005). The increase in LDL-C may therefore be at least partially explained by the loss of the positive action of tamoxifen.…”

“…We found that 1-year's use of exemestane led to more changes in cholesterol parameters, which are commonly associated with an increased risk of coronary heart disease (Table 3), thus indicating that the lipid profiles of patients receiving exemestane or other aromatase inhibitors should be monitored. However, it must be borne in mind that the genesis of cardiovascular diseases is multifactorial, and many authors have found that exemestane treatment significantly reduces triglyceride levels, which may help to balance the negative effect of the decrease in HDL-C (Atalay et al, 2004;Markopoulos et al, 2005). Only large-scale randomised trials and a long follow-up can answer the question as to whether postmenopausal women treated with exemestane or other aromatase inhibitors for 3 -5 years are at greater cardiovascular risk than those treated with tamoxifen.…”

“…Recent findings have shown that, in comparison with standard 5-year tamoxifen therapy, the administration of exemestane after 2 -3 years of tamoxifen significantly improves disease-free survival in postmenopausal women with primary breast cancer (Coombes et al, 2004). Although many of the adverse effects associated with tamoxifen and exemestane have been analysed, there are no comparative data concerning their effects on body composition and body weight; furthermore, there are few published data concerning the impact of adjuvant exemestane therapy on lipid profiles (Atalay et al, 2004;Markopoulos et al, 2005). The aim of this study was to evaluate the changes in the body composition and lipid profiles of postmenopausal women switched from tamoxifen to exemestane.…”

Lipid Adjustment in the Analysis of Environmental Contaminants and Human Health Risks

“…For example, research indicates a possible causal effect of PCBs on serum lipid levels (Hennig et al 2005; Langer et al 2003). Additionally, lipid levels have been suggested to affect breast cancer risk (Atalay et al 2004), but their impact on other health end points has received limited attention. For our purposes in this study, our scenarios, hypothetical “causal truths,” are based on the literature and their relation to frequently used statistical models.…”