Currently Viewing:
Newsroom
Currently Reading
Cholesterol-Lowering Medications Complement Endocrine Therapy in Breast Cancer
February 21, 2017 – Surabhi Dangi-Garimella, PhD
What We're Reading: Alzheimer's Among Latinos; UnitedHealth Lawsuit; and Use of Wearable Devices
February 20, 2017 – AJMC Staff
OlympiAD Trial Reports Success With Olaparib and Predictive Diagnostic Test
February 19, 2017 – Surabhi Dangi-Garimella, PhD
Pharma—PBM War on Drug Prices Picks Up Steam
February 17, 2017 – Surabhi Dangi-Garimella, PhD
This Week in Managed Care: February 17, 2017
February 17, 2017
Experimental Treatment Induces Remission in Multiple Sclerosis
February 16, 2017 – Laura Joszt
Postmenopausal Weight Loss Cuts Risk of Endometrial Cancer by Half
February 16, 2017 – Surabhi Dangi-Garimella, PhD
UCSF Researchers Identify Determinants of Coverage for Hereditary Cancer Panels
February 15, 2017 – Surabhi Dangi-Garimella, PhD
Breast Cancer Survivors Report More Cognitive Impairment After Chemotherapy
February 15, 2017 – Christina Mattina

Cholesterol-Lowering Medications Complement Endocrine Therapy in Breast Cancer

Surabhi Dangi-Garimella, PhD
Including anti-cholesterol agents during adjuvant endocrine treatment can prevent breast cancer recurrence in hormone receptor—positive early-stage breast cancer.
Including anti-cholesterol agents during adjuvant endocrine treatment can prevent breast cancer recurrence in hormone receptor–positive early-stage breast cancer. These are the findings of an observational study published in the Journal of Clinical Oncology that analyzed phase 3 data from the BIG 1-98 trial.

Between 1998 and 2003, the Breast International Group (BIG) enrolled 8010 postmenopausal women with early-stage, estrogen receptor–positive invasive breast cancer. Patients in the 2-arm part of the study received either 20 mg tamoxifen daily or 2.5 mg letrozole (an aromatase inhibitor) daily, for 5 years. The 4-arm option included 2 sequential arms of tamoxifen for 2 years and then letrozole for 3 years or, letrozole for 2 years followed by tamoxifen for 3 years.

Study end points were disease-free survival (DFS), breast cancer–free interval (BCFI), and distant recurrence–free interval (DRFI). Total cholesterol levels were measured at baseline, when the patient enrolled in the study, and then every 6 months for up to 5.5 years.

The authors observed an influence of tamoxifen on serum cholesterol levels, which reduced during tamoxifen treatment and rose back up once treatment stopped—irrespective of whether tamoxifen was administered alone, prior to, or after letrozole. However, letrozole did not have any effect on cholesterol levels.

Only a small proportion (8%) of the 7963 patients who received at least 1 dose of the study therapy, reported prior exposure to a cholesterol-lowering drug when they started endocrine treatment. These patients were typically older, nonsmokers, had diabetes, a cardiac medical history, smaller tumors, and fewer positive lymph nodes at diagnosis. Compared with the remaining 92% of patients not exposed to anti-cholesterol medication, these patients had,

  • 18% reduction in DFS hazard (DFS hazard ratio [HR]adj, 0.82; 95% CI, 0.68 to 0.99)
  • 17% reduction in disease recurrence (BFCI HRadj, 0.83; 95% CI, 0.65 to 1.06)
  • 19% lower hazard of distant recurrence (DRFI HRadj, 0.81; 95% CI, 0.61 to 1.09
Of the majority of patients who started on a cholesterol-lowering drug for the first time during the trial, 5% who were receiving tamoxifen had started on these drugs by 5 years of treatment, which was much higher than those receiving letrozole. These anti-cholesterol agents, the authors found, improved all 3 outcomes being evaluated: DFS (HRadj, 0.79; 95% CI, 0.66 to 0.95; P = .01), BCFI (HRadj, 0.76; 95% CI, 0.60 to 0.97; P = .02), and DRFI (HRadj, 0.74; 95% CI, 0.56 to 0.97; P = .03).

For patients in the monotherapy arms, initiating anti-cholesterol medication had no significantly beneficial effect for patients receiving either tamoxifen or letrozole.

The results indicate that baseline use of anti-cholesterol medication improves outcomes in patients with breast cancer receiving endocrine treatment. However, patients receiving the aromatase inhibitor letrozole seemed to benefit more than others if they received cholesterol-lowering drugs during endocrine treatment.

Reference

Borgquist S, Giobbie-Hurder A, Ahern TP, et al. Cholesterol, cholesterol-lowering medication use, and breast cancer outcome in the BIG 1-98 study [published online February 13, 2017]. J Clin Oncol. doi: 10.1200/JCO.2016.70.3116.

 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up