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Annals of Oncology Advance Access published online on July 19, 2005
Annals of Oncology, doi:10.1093/annonc/mdi322
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© 2005 European Society for Medical Oncology
Received March 10, 2005
Revised June 1, 2005
Accepted June 15, 2005

Original article

Comparative effects of anastrozole, tamoxifen alone and in combination on plasma lipids and bone-derived resorption during neoadjuvant therapy in the impact trial

S. Banerjee 1, I. E. Smith 1*, L. Folkerd 2, J. Iqbal 2, P. Barker 3, M. Dowsett 2, and On behalf of the IMPACT trialists

1 Breast Unit, Royal Marsden Hospital, London & Sutton, UK
2 Academic Department of Biochemistry, Royal Marsden Hospital, London, UK
3 AstraZeneca, Macclesfield, UK

* To whom correspondence should be addressed.
I. E. Smith, E-mail: ian.smith{at}rmh.nthames.nhs.uk


  Abstract

Background: Estrogen has beneficial effects on lipid metabolism and bone preservation. The IMPACT trial evaluated neoadjuvant therapy with anastrozole or tamoxifen alone, or a combination. The comparative effects of these treatments on serum lipids and bone resorption were assessed.

Patients and methods: Non-fasting clotted blood samples were taken from 176 postmenopausal patients at baseline, 2 and 12 weeks for assessment of serum levels of estradiol, the bone resorption marker CTx and lipid profiles [total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and non-HDL cholesterol (N-HDL-C)].

Results: After 12 weeks, tamoxifen was associated with a significant increase in HDL-C (26.5%), and a decrease in TC (6.5%) and N-HDL-C (12.3%). Anastrozole was associated with a significant increase in HDL-C (11.2%), and a non-significant increase in TC (2.9%) and N-HDL-C (3.4%), both of which were significantly different from tamoxifen. The combination was associated with a significant increase in HDL-C (9.4%), and a decrease in TC (10.9%) and N-HDL-C (13.9%). For tamoxifen and the combination, there were non-significant decreases in CTx compared with a significant increase (45.6%) with anastrozole. No correlation between serum estradiol and CTx was seen in any of the treatment groups.

Conclusion: Anastrozole did not have a detrimental effect on lipid profiles following 3 months of therapy. There was a significant increase in CTx with anastrozole in contrast to tamoxifen.

Keywords: anastrozole; bone; breast cancer; lipids; neoadjuvant; tamoxifen.
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