유방암환자에서 아로마타제 억제제 및 칼슘/비타민D 복합제 병용투여의 골다공증 예방효과
Prevention of Osteoporosis in Patients With Breast Cancer Treated With Aromatase Inhibitor Combined With Calcium/Vitamin D Supplements
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Purpose: Tamoxifen and aromatase inhibitor (AI) are used for hormone therapy for hormone-positive breast cancer, and AI is well known to decrease bone mineral density (BMD). The authors compared the serial BMD of patients with hormone-positive breast cancer to evaluate the preventive effect of AI combined with calcium and vitamin D (Ca/Vit D) supplements. Methods: A total of 249 women with hormone-positive breast cancer who underwent serial BMD assessments between 2011 and 2015 were included. The patients were classified as the tamoxifen alone group (n=23), AI with Ca/Vit D group (n=139), and extended regimen from tamoxifen to AI with Ca/Vit D group (n=87). Moreover, osteoporosis was diagnosed based on the World Health Organization guideline. Results: The incidence of osteoporosis was highest in the AI with Ca/Vit D group (n=50, 36.0%) and lowest in the tamoxifen only group (n=4, 17.4%). Furthermore, it showed statistical difference between the three groups (p=0.003). However, considering the baseline of initial BMD in each patient, the mean change value did not show any statistical difference between the three groups (p=0.498). Moreover, the lumbar T-scores were lower than that of the total hip T-scores in each patient. Conclusion: Although it has been reported that osteoporosis is common in patients treated with AI, the decreased BMD was not significantly severe compared to that in the tamoxifen alone group if Ca/Vit D was administrated with AI. Therefore, Ca/Vit D has some preventive effect for osteoporosis in patients treated with AI.
Abstract
Purpose: Tamoxifen and aromatase inhibitor (AI) are used for hormone therapy for hormone-positive breast cancer, and AI is well known to decrease bone mineral density (BMD). The authors compared the serial BMD of patients with hormone-positive breast cancer to evaluate the preventive effect of AI combined with calcium and vitamin D (Ca/Vit D) supplements. Methods: A total of 249 women with hormone-positive breast cancer who underwent serial BMD assessments between 2011 and 2015 were included. The patients were classified as the tamoxifen alone group (n=23), AI with Ca/Vit D group (n=139), and extended regimen from tamoxifen to AI with Ca/Vit D group (n=87). Moreover, osteoporosis was diagnosed based on the World Health Organization guideline. Results: The incidence of osteoporosis was highest in the AI with Ca/Vit D group (n=50, 36.0%) and lowest in the tamoxifen only group (n=4, 17.4%). Furthermore, it showed statistical difference between the three groups (p=0.003). However, considering the baseline of initial BMD in each patient, the mean change value did not show any statistical difference between the three groups (p=0.498). Moreover, the lumbar T-scores were lower than that of the total hip T-scores in each patient. Conclusion: Although it has been reported that osteoporosis is common in patients treated with AI, the decreased BMD was not significantly severe compared to that in the tamoxifen alone group if Ca/Vit D was administrated with AI. Therefore, Ca/Vit D has some preventive effect for osteoporosis in patients treated with AI.
참고문헌 (25)
- Onitilo AA, "Breast cancer subtypes based on ER", PR and Her2 expression : comparison of clinicopathologic features and survival, 2009, pp.7, 4~13
- Legha SS, "Tamoxifen in the treatment of breast cancer", Ann Intern Med, 109, pp.219~228 (1988)
- Allison KH, "Estrogen and progesterone receptor testing in breast cancer : ASCO", CAP guideline update, 2020, pp.38, 1346~1366
- Burstein HJ, "Adjuvant hormonal therapy for early-stage breast cancer", Surg Oncol Clin N Am, 19, pp.639~647 (2010)
- Goldberg J, "The immunology of hormone receptor positive breast cancer", Front Immunol, 12, pp.674192~ (2021)
- Davies C, "Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen : patient-level meta-analysis of randomised trials", Lancet, 378, pp.771~784 (2011)
- Fisher B, "A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors", N Engl J Med, 320, pp.479~484 (1989)
- Regan MM, "Assessment of letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancer : the BIG 1-98 randomised clinical trial at 8·1 years median follow-up", Lancet Oncol, 12, pp.1101~1108 (2011)
- Hadji P, "The effect of exemestane and tamoxifen on bone health within the Tamoxifen Exemestane Adjuvant Multinational(TEAM)trial : a meta-analysis of the US, German, Netherlands, and Belgium sub-studies", J Cancer Res Clin Oncol, 137, pp.1015~1025 (2011)
- Smith IE, "Aromatase inhibitors in breast cancer", N Engl J Med, 348, pp.2431~2442 (2003)
- Early Breast Cancer Trialists’ Collaborative Group, "Aromatase inhibitors versus tamoxifen in early breast cancer : patient-level meta-analysis of the randomised trials", Lancet, 386, pp.1341~1352 (2015)
- Cuzick J, "Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer : 10-year analysis of the ATAC trial", Lancet Oncol, 11, pp.1135~1141 (2010)
- Osborne CK, "Tamoxifen in the treatment of breast cancer", N Engl J Med, 339, pp.1609~1618 (1998)
- Fisher B, "Tamoxifen for prevention of breast cancer : report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study", J Natl Cancer Inst, 90, pp.1371~1388 (1998)
- Cuzick J, "Anastrozole for prevention of breast cancer in high-risk postmenopausal women(IBIS-II) : an international, double-blind, randomised placebo-controlled trial", Lancet, 383, pp.1041~1048 (2014)
- Goss PE, "Exemestane for breast-cancer prevention in postmenopausal women", N Engl J Med, 364, pp.2381~2391 (2011)
- Geisler J, "Impact of aromatase inhibitors on bone health in breast cancer patients", J Steroid Biochem Mol Biol, 118, pp.294~299 (2010)
- Amir E, "Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients : a systematic review and meta-analysis", J Natl Cancer Inst, 103, pp.1299~1309 (2011)
- Presant CA, "Aromatase inhibitor-associated arthralgia and", or bone pain : frequency and characterization in non-clinical trial patients, 2007, pp.7, 775~778
- Sang Hoon Park, "Effect of Vitamin D on Bone Mineral Density Changes in Patients with Breast Cancer Receiving Adjuvant Aromatase Inhibitor Therapy", Journal of Breast Disease, 7(2), pp.105~112 (2019), 한국유방암학회[DOI]
- Love RR, "Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer", N Engl J Med, 326, pp.852~856 (1992)
- Mauri D, "Survival with aromatase inhibitors and inactivators versus standard hormonal therapy in advanced breast cancer : meta-analysis", J Natl Cancer Inst, 98, pp.1285~1291 (2006)
- Eastell R, "Effect of an aromatase inhibitor on bmd and bone turnover markers : 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination(ATAC)trial(18233230)", J Bone Miner Res, 21, pp.1215~1223 (2006)
- Gralow JR, "NCCN task force report : bone health in cancer care", J Natl Compr Canc Netw, 11(Suppl 3), pp.S1~S50 (2013)
- Burstein HJ, "Systemic therapy for estrogen receptor-positive, HER2-negative breast cancer", N Engl J Med, 383, pp.2557~2570 (2020)