title: Can we use gonadotropin plasma concentration as surrogate marker for BMI-related incomplete estrogen suppression in breast cancer patients receiving anastrozole?
abstract: BMI has been suggested to impact on estrogenic activity in patients receiving anastrozole resulting in a reduced treatment efficacy in obese women. Current evidence in this regard is controversially discussed. Since estradiol is inversely correlated with gonadotropins it can be assumed that an impact of BMI is also reflected by gonadotropin plasma concentrations. We aim at investigating the impact of BMI on the hormonal state of breast cancer (BC) patients receiving anastrozole indicated by LH, FSH and SHBG as well as estradiol.
  
  
  
  We determined gonadotropin-, estradiol- and anastrozole- serum concentrations from postmenopausal, early stage breast cancer patients receiving upfront anastrozole within routine after care. Gonadotropin plasma concentrations were derived from the routine laboratory examination report. A liquid chromatography tandem mass spectrometry method was used for the measurement of anastrozole serum concentrations. BMI was assessed within the routine after-care check-up.
  
  
  
  The overall sample comprised 135 BC patients with a mean age of 65.3 years. BMI was significantly correlated with LH, FSH and SHBG. This association was neither influenced by age nor by anastrozole serum concentrations according to the regression model. Despite aromatase inhibition 12% of patients had detectable estrogen levels in routine quantification.
  
  
  
  Obese women have an altered hormonal situation compared to normally weight women under the same dose of anastrozole. Our study findings are a further indicator for the relevance of BMI in regard of anastrozole metabolism and possible estrogenic activity indicated by gonadotropin plasma level.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Oberguggenberger
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Meraner
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Sztankay
authors.affiliation: Institute of Legal Medicine and Core Facility Metabolomics, Innsbruck Medical University, Muellerstrasse 44, 6020, Innsbruck, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Beer
authors.affiliation: Central Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Weigel
authors.affiliation: Institute of Legal Medicine and Core Facility Metabolomics, Innsbruck Medical University, Muellerstrasse 44, 6020, Innsbruck, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Oberacher
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Kemmler
authors.affiliation: Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Czech
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Holzner
authors.affiliation: Department of Gynecological Endocrinology and Reproductive Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Wildt
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Sperner-Unterweger
authors.affiliation: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Daniaux
authors.affiliation: Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria. michael@hubalek.at.
authors.forename: M
authors.identifier: 0000-0003-2346-7431
authors.initials: M
authors.lastname: Hubalek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000077384:Anastrozole; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D006062:Gonadotropins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009570:Nitriles / Q000627:therapeutic use*; D009765:Obesity / Q000503:physiopathology; D017698:Postmenopause; D011379:Prognosis; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D047072:Aromatase Inhibitors; D015415:Biomarkers; D004967:Estrogens; D006062:Gonadotropins; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole
keywords: Aromatase inhibitor; Body mass index; Breast cancer; Estradiol; Gonadotropins