This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Effects of aromatase inhibitors and body mass index on steroid hormone levels in women with early and advanced breast cancer. BJS 2014; 101: 939-948.

Published: 31st March 2014

Authors: K. M. Elliott, J. Dent, F. Z. Stanczyk, L. Woodley, R. C. Coombes, A. Purohit et al.

Background

Aromatase inhibitors (AIs) are central to the management of oestrogen receptor‐positive breast cancer in the adjuvant and metastatic setting. Levels of circulating steroid hormones (SHs) were measured in patients established on AIs to investigate: the influence of body mass index (BMI) in both the adjuvant and metastatic setting; the class of AI utilized in the adjuvant setting (steroidal versus non‐steroidal); and differences in SH levels between women treated adjuvantly and those receiving a second‐line AI for locally advanced/metastatic disease.

Method

Plasma levels of androstenedione, 5‐androstene‐3β,17β‐diol, dehydroepiandrosterone, oestradiol and testosterone were measured by radioimmunoassay in women with breast cancer who were receiving AIs in either an adjuvant or a metastatic setting. Differences between mean SH levels by class of AI, BMI, and second‐line versus adjuvant therapy were assessed.

Results

Sixty‐four women were receiving AI therapy, 45 (70 per cent) in an adjuvant setting and 19 (30 per cent) were taking a second‐line AI. There was no significant correlation between BMI and SH levels. However, BMI was significantly higher in the second‐line AI cohort compared with the adjuvant cohort (29·8 versus 26·2 kg/m² respectively; P = 0·026). In the adjuvant setting, patients receiving a steroidal AI had significantly higher levels of all five hormones (P < 0·050). In the second‐line AI cohort, oestradiol levels were significantly higher than in the adjuvant cohort (4·5 versus 3·3 pg/ml respectively; P = 0·022). Multivariable analysis adjusted for BMI confirmed the higher residual oestradiol level in the second‐line AI group (P = 0·063) and a significantly higher androstenedione level (P = 0·022).

Conclusion

Residual levels of SH were not significantly influenced by BMI. However, the significant differences in residual SH levels between the second‐line and adjuvant AI cohort is of relevance in the context of resistance to AI therapy, and warrants further investigation.

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