Effect of denosumab administration on low bone mineral density (T-score −1.0 to −2.5) in postmenopausal Japanese women receiving adjuvant aromatase inhibitors for non-metastatic breast cancer

PURPOSE Tamoxifen is currently the standard hormonal treatment of breast cancer, both for metastatic disease and in the adjuvant setting. A new antiestrogen, toremifene, was approved recently for use in managing metastatic breast cancer in postmenopausal women. METHODS Toremifene is structurally similar to tamoxifen, differing only by a single chlorine atom, and has a similar pharmacologic profile. The major difference between the two compounds is in the preclinical activity; chronic, high-dose tamoxifen is hepatocarcinogenic in the rat, whereas toremifene is not. Neither agent is hepatocarcinogenic in mice, hamsters, or humans; therefore, clinical relevance of the rat data may not be significant. RESULTS In a worldwide phase III trial, the two agents demonstrated comparable efficacy and safety against metastatic breast cancer. Both agents have shown a significant hypocholesterolemic effect after long-term administration. CONCLUSION Due to the paucity of long-term clinical data on toremifene, important unresolved questions remain, which include its effects on bone mineral density, the frequency of cardiac events, and the risk for endometrial cancer. Tamoxifen has been associated with maintenance of bone mineral density, a reduction in cardiac events, and a slightly increased risk of endometrial cancer. Toremifene is not likely to be used as second-line therapy after tamoxifen failure due to cross-resistance, and its ultimate place in therapy of advanced breast cancer remains to be determined.

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Changes on Bone Mineral Density after Adjuvant Treatment in Women with Non-metastatic Breast Cancer

Breast Cancer Research and Treatment ◽

10.1007/s10549-005-3803-0 ◽

2005 ◽

Vol 93 (1) ◽

pp. 75-83 ◽

Cited By ~ 13

Author(s):

Luz-Milva Rodríguez-Rodríguez ◽

Eva-María Rodríguez-Rodríguez ◽

Juana-María Oramas-Rodríguez ◽

Francisco Santolaria-Fernandez ◽

Marta Llanos ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Metastatic Breast Cancer ◽

Bone Mineral ◽

Adjuvant Treatment ◽

Metastatic Breast ◽

Mineral Density

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Evaluation with densitometry of patients with breast cancer and low bone mineral density after 2 years of treatment

Bone Abstracts ◽

10.1530/boneabs.1.pp425 ◽

2013 ◽

Author(s):

Sonia Munoz Gil ◽

Tomas Mut Dolera ◽

Belen C Garrido Lopez ◽

M D Torregrosa Maicas ◽

R Girones Sarrio ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Bone Mineral ◽

Mineral Density ◽

Low Bone Mineral Density

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Managing bone health in women with breast cancer under adjuvant treatment with aromatase inhibitors: pretreatment bone mineral density is important

Breast Cancer Research ◽

10.1186/bcr2609 ◽

2010 ◽

Vol 12 (4) ◽

Cited By ~ 1

Author(s):

Christos Markopoulos

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Bone Mineral ◽

Aromatase Inhibitors ◽

Adjuvant Treatment ◽

Bone Health ◽

Mineral Density

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Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors

Journal of Oncology Practice ◽

10.1200/jop.2016.018341 ◽

2017 ◽

Vol 13 (5) ◽

pp. e505-e515 ◽

Cited By ~ 3

Author(s):

Jamie Stratton ◽

Xin Hu ◽

Pamela R. Soulos ◽

Amy J. Davidoff ◽

Lajos Pusztai ◽

...

Keyword(s):

Breast Cancer ◽

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Aromatase Inhibitors ◽

Early Stage ◽

Mineral Density ◽

Dxa Scan ◽

Bone Mineral Density Testing

Purpose: In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years. How often this recommendation is followed is unclear. Methods: We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use. We used multivariable logistic regression to investigate associations between patient characteristics and receipt of a baseline DXA scan. In patients who continued AI treatment, we assessed rates of follow-up scans. Results: In the sample of 2,409 patients (median age, 74 years), 51.0% received a baseline DXA scan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2 years and 65.9% within 3 years. In aggregate, of the 1,164 patients who continued with AI treatment for 3 years, only 34.5% had both a baseline and at least one DXA scan during the 3-year follow-up period. Conclusion: The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.

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