ABSTRACT
BACKGROUND: Fulvestrant is a pure anti-estrogen hormoal agent formally lacking any estrogen-agonist activity. We analyze the effect(s) of fulvestrant treatment on estrogen target systems in hormoe-sensitive advanced breast cancer patients. RESULTS: Patients received a median of five fulvestrant injections (range 3-19). We observed a partial response in one patient, disease stability in 21 and disease progression in 29 patients with a clinical benefit of 43.2% and a median time to progression of 5 [range 3-20] mo. Total cholesterol levels significantly decreased during treatment (219.8 +/- 45.3 vs. 201.4 +/- 42.1 mg/dl; p = 0.0054) together with LDL-cholesterol (129.7 +/- 41.39 vs. 112.3 +/- 37.1 mg/dl; p = 0.018). HDL-cholesterol and triglycerides did not show significant changes. Reduction of total and LDL-cholesterol was independent from last hormoal treatment or treatment duration. All coagulation indices and mean endometrial mucosa thickness value did not vary. METHODS: Fifty-one patients [median age 65 (range 48-82) y] were enrolled. All patients received previous hormoal treatments, with 90.2% receiving > or =2 courses. Last hormoal treatment was exemestane, letrozole, anastrozole and other in 30-10-7-4/51 patients respectively. Median withdrawal time was 18 d (range 3-1456). Complete fasting lipid blood profile and coagulation indices were assessed before fulvestrant administration, every 3 mo and at discontinuation time. Endometrial mucosa thickness was evaluated before fulvestrant administration and at end-study time. CONCLUSIONS: We observed a lipid lowering effect of fulvestrant possibly related to an influence on lipid metabolism by a mechanism in which a role could be played by progesterone receptor.
Subject(s)
Adenocarcinoma/secondary , Antineoplastic Agents, Hormonal/pharmacology , Breast Neoplasms/drug therapy , Cholesterol/blood , Estradiol/analogs & derivatives , Estrogen Receptor Modulators/pharmacology , Estrogens , Neoplasm Proteins/analysis , Neoplasms, Hormone-Dependent/secondary , Progesterone , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Adenocarcinoma/blood , Adenocarcinoma/drug therapy , Aged , Aged, 80 and over , Antineoplastic Agents, Hormonal/therapeutic use , Aromatase Inhibitors/pharmacology , Aromatase Inhibitors/therapeutic use , Breast Neoplasms/blood , Breast Neoplasms/pathology , Cholesterol, LDL/blood , Endometrium/drug effects , Endometrium/ultrastructure , Estradiol/pharmacology , Estradiol/therapeutic use , Estrogen Receptor Modulators/therapeutic use , Female , Fulvestrant , Humans , Lipid Metabolism/drug effects , Middle Aged , Neoplasms, Hormone-Dependent/blood , Neoplasms, Hormone-Dependent/drug therapy , Neoplasms, Hormone-Dependent/pathology , Postmenopause , Prospective Studies , Receptors, Estrogen/drug effects , Receptors, Progesterone/drug effects , Receptors, Progesterone/physiology , Triglycerides/bloodABSTRACT
Chemoradiation is a standard approach to advanced unresectable head and neck cancer, although the optimum combination regimen remains controversial. However, in the past few years, chemoradiation has been successfully extended from the treatment of unresectable disease to the postsurgical therapy of high-risk patients and its value as an organ preservation procedure is under evaluation. More recently, molecular-targeted therapies have emerged, which interfere with mechanisms of chemo- and radioresistance, and preliminary data are promising. Their use in the combined treatment of head and neck cancer will hopefully further improve the value of chemoradiation in the clinical setting.
