title: Tamoxifen and aromatase inhibitors differentially affect vascular endothelial growth factor and endostatin levels in women with breast cancer.
abstract: OBJECTIVE
  Circulating and cellular proangiogenic and antiangiogenic proteins such as vascular endothelial growth factor (VEGF) and endostatin contribute to the local angiogenic balance. We explored the effects of tamoxifen and aromatase inhibitors on concentrations of VEGF and endostatin in plasma, serum, and platelet releasate (induced by platelet activation).
  
  
  METHODS
  VEGF and endostatin concentrations were measured with a quantitative immunoassay before and after 1 to 5 weeks of treatment in 30 women with breast cancer treated with either tamoxifen (n = 14) or aromatase inhibitors (n = 16). Platelet activation was induced by a thrombin receptor agonist.
  
  
  RESULTS
  Tamoxifen therapy resulted in an increase in platelet releasate concentrations of VEGF (P = 0.01) but no change in plasma VEGF. In contrast, aromatase inhibitor therapy did not affect serum, plasma, or platelet releasate VEGF. In univariate analysis, aspirin use attenuated the tamoxifen-associated increase in VEGF in the platelet releasate and decreased serum levels of VEGF (P = 0.03). Aromatase inhibitor therapy resulted in a decrease in serum endostatin concentrations (P = 0.04), whereas plasma concentrations of endostatin tended to be higher during treatment with aromatase inhibitors (P = 0.06). Tamoxifen therapy resulted in no change in serum or plasma endostatin concentrations. Platelet releasate concentrations of endostatin did not change with either treatment. Interindividual variability was noted among both aromatase inhibitor--and tamoxifen-treated patients.
  
  
  CONCLUSIONS
  Tamoxifen and aromatase inhibitor therapy affect VEGF and endostatin levels and likely contribute to the angiogenic balance in breast cancer patients. Aspirin decreased the proangiogenic effects of tamoxifen, suggesting that antiplatelet and/or antiangiogenic therapy might improve the effectiveness of tamoxifen in women with breast cancer.
authors.affiliation: Department of Medicine, University of Vermont, Burlington, Vermont, USA. ceholmes@uvm.edu
authors.forename: Chris E
authors.initials: CE
authors.lastname: Holmes
authors.forename: Joe C
authors.initials: JC
authors.lastname: Huang
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pace
authors.forename: Alan B
authors.initials: AB
authors.lastname: Howard
authors.forename: Hyman B
authors.initials: HB
authors.lastname: Muss
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy; D043169:Endostatins / Q000097:blood / Q000187:drug effects*; D005260:Female; D006801:Humans; D007118:Immunoassay; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood* / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D043169:Endostatins; D010975:Platelet Aggregation Inhibitors; D020845:Selective Estrogen Receptor Modulators; D042461:Vascular Endothelial Growth Factor A; D013629:Tamoxifen; D001241:Aspirin