Jean, and others who have asked me for an article on the relative merits of the diff-

[Lani]

rent AIs:

The Breast Journal
Volume 15 Issue 2, Pages 194 - 198
Published Online: 9 Mar 2009


SHORT COMMUNICATION
Enhancing the Adjuvant Treatment of Hormone Receptor Positive Breast Cancer
Mitchel Barry, MD, MRCSI and Malcolm R. Kell, MD, FRCSI
Breastcheck, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
Address correspondence and reprint requests to: Malcolm R. Kell, MD, FRCSI, Breastcheck, Mater Misericordiae University Hospital, University College Dublin, 36 Eccles St, Dublin, Ireland, or e-mail: malcolm.kell@breastcheck.ie
KEYWORDS
aromatase inhibitors • optimum adjuvant treatment • anastrozole • letrozole
ABSTRACT
Abstract: Aromatase inhibitors (AIs) are now regarded as the optimum hormonal therapy for postmenopausal women with hormone receptor positive breast cancer. However, it is unclear which of the currently available AIs offers patients the most effective and the best-tolerated treatment strategy. We performed a systematic review and meta-analysis of randomized-controlled trials that compared AIs (as first-line agents) with standard hormonal treatment in patients with breast cancer. The results suggest that letrozole offers a more favorable side-effect profile particularly in terms of musculoskeletal adverse events. However, the available data suggests a small survival benefit from the use of anastrozole although patients treated with anastrozole appear to have a more favorable disease profile at study entry. Examination of survival data on adjuvant tamoxifen therapy from these trials supports this observation.

[Hopeful]

Lani, this is interesting, as Letrozole (Femara) is a more potent suppressor of aromatase than Anastrazole (Arimidex). Could it be the metabolization of the drug, rather than the absolute value of circulating ER achieved, that is the difference? If so, it would mean a lot to those of us using topical estrogens to combat the side effects of the AIs.

Hopeful

[Lani]

the level of the bc cell which may make (or its surrounding stoma makes) their own hormones:

GUMC Researchers: Test for Hormones in the Blood Not Reflective of Hormones in Breast Tissue; Breast Cancer Risk

Denver, Colo. – Many studies determine hormone levels in the blood as a marker of breast cancer risk. But it hasn’t been known whether these blood tests reflect what is happening in the breast tissue, where certain hormones fuel cancer. Researchers at Georgetown University Medical Center’s (GUMC) Lombardi Comprehensive Cancer Center found that measuring the levels of four hormones in blood known to be linked to breast cancer doesn’t necessarily reflect the levels of these hormones in the breast tissue itself.

In fact, the scientists say that blood tests used in research studies that measure these hormones could give a false impression of both the real breast cancer risk women face, and an imprecise picture of how these hormones affect breast cancer development. The findings are being presented at the Annual Meeting of the American Association for Cancer Research.

“We know from this study that measuring the hormones in a patient’s blood is not sufficient but that is how many research studies looking at breast cancer risk are being conducted,” says the study’s lead author, Adana Llanos, a graduate student in genetics at GUMC. “Understanding how cancers develop in breast tissue is the key to prevention, and we need to understand how these hormones affect breast tissue.”

The research team, led by Llanos and under the guidance of senior investigator, Peter G. Shields, MD, head of Lombardi’s Cancer Genetics and Epidemiology Program, did something that has not been done before: They tested normal breast tissue for the levels of IGF-1, IGFBP-3, adiponectin, and leptin. High levels of IGF-1 has been linked to breast cancer development, while low levels of IGFBP-3 is linked to increased risk. High levels of adiponectin and leptin are both related to obesity, which is, in itself, a risk factor for breast cancer.

“By understanding these hormones in the normal breast environment, we will have some insight into how early changes in the breast lead to breast cancer,” Llanos says. The researchers asked 15 women who were undergoing breast reduction surgery to participate in the study, and then collected three samples of discarded tissue from each breast, as well as blood, and extensive epidemiological data.

They first assessed whether levels of these hormones were the same in each of the three tissue samples taken from the women, which represented different areas of the breast. “We found that the hormones were distributed in the same way across the breast, which is a good thing to know because it means that a tissue biopsy taken from one part of the breast will likely represent the breast as a whole,” says Llanos.

They then tested the blood to see if levels of the hormones matched those found in the breast tissue, and found that leptin, adiponectin, and IGFBP-3 correlated, whereas IGF-1 did not. But even that may be misleading, Llanos says, because hormone levels may differ between a woman’s two breasts. “Breast cancer usually develops in a single breast, so it is not clear that looking at these hormones in the blood is sufficient,” she says.

“If we want to know what is occurring in the breast, then we have to go to the tissue itself,” Llanos says. “Measuring blood would be more convenient, but our study shows that, alas, this may not be accurate.”

Llanos and her co-authors report no related financial interests. This work was funded by a grant from the Department of Defense.

[Hopeful]

This is the statement that is fascinating to me:

"But even that may be misleading, Llanos says, because hormone levels may differ between a woman’s two breasts. “Breast cancer usually develops in a single breast, so it is not clear that looking at these hormones in the blood is sufficient,” she says."

So, the million dollar question is, why are gene changes limited to one breast and not the other? Or why do excess hormones collect in one and not the other?

I like things that make me think!

Hopeful

[StephN]

In the case of a patient who is triple negative, could the above findings be why that person might be given Tamoxifin???

Lani - I met a Chinese researcher at AACR who works in this country and whose wife was diagnosed last summer with breast cancer, triple negative. He said she had surgery and was being given tamoxifin. He was very worried about all that and seemed to find that he could speak with me about his fears.

I was a little puzzled about the treatment he outlined for his wife.

[Jean]

Thank you Lani, I appreciate your attention.

Hopeful,
I understand your thoughts - and in thinking about
the breast and the difference of hormonal levels in each one...like any other apendage of our body, such as our legs, one leg could have a cancer tumor while the other leg would not be involved. Maybe I am making it too simple in thought...but I have always felt that each breast is independent of the other in hormones, as I noticed when breast feeding there would be more available milk sometimes in one breast verses the other,
does this sound crazy?

jean