title: Comparative effects of anastrozole, tamoxifen alone and in combination on plasma lipids and bone-derived resorption during neoadjuvant therapy in the impact trial.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Breast Unit, Royal Marsden Hospital, London & Sutton, London, UK.
authors: S
authors: S
authors: Banerjee
authors: I E
authors: IE
authors: Smith
authors: L
authors: L
authors: Folkerd
authors: J
authors: J
authors: Iqbal
authors: P
authors: P
authors: Barker
authors: M
authors: M
authors: Dowsett
mesh_terms: D000368:Aged; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000188:drug therapy; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D004311:Double-Blind Method; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D017698:Postmenopause; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015415:Biomarkers; D008055:Lipids; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D004958:Estradiol