Abstract
BackgroundTo evaluate effects of neoadjuvant chemotherapy on the bone turnover markers of preoperational breast cancer patients.MethodsForty-one breast cancer patients (29 premenopausal and 12 postmenopausal) and 60 healthy women (30 premenopausal and 30 postmenopausal) aged 30-64 years, were evaluated for their bone status. Serum levels of the bone formation markers PINP and BAP, as well as the resorption markers ICTP and β-Crosslaps in addition to E2, FSH, 25(OH)D and PTH were measured at the initial diagnosis and at 24 hours after each four chemotherapy cycles. BMD T-scores were determined in 12 patients 6 months after the neoadjuvant chemotherapies.ResultsThe baseline levels of both bone formation and resorption markers in premenopausal patients were higher than in premenopausal healthy women (p<0.05), while no statistic difference was observed between postmenopausal patients and postmenopausal healthy women. Regardless of the menopausal status, chemotherapy increased the ICTP and β-Crosslaps levels (p<0.05), but decreased the BAP and PINP levels (p<0.05), the later one significantly more with Taxane medication (p<0.01, p<0.05). Chemotherapy caused significant decreases of 25(OH)D levels in premenopausal (p<0.01) and postmenopausal (p<0.05) patients, however, did not affect the PTH concentrations. In premenopausal patients the E2 level decreased, while the FSH level increased after chemotherapy (p<0.05). Patients with pronounced ICTP and β-Crosslaps combined with reduced BAP and PINP serum concentrations after neoadjuvant chemotherapies were prone to develop osteoporosis 6 month later.ConclusionsNeoadjuvant chemotherapy appeared to promote bone resorption and inhibit bone formation in both postmenopausal and premenopausal early-stage breast patients.
Highlights
Breast cancer is the most common malignant tumor in women
Patients with pronounced ICTP and β-Crosslaps combined with reduced BAP and PINP serum concentrations after neoadjuvant chemotherapies were prone to develop osteoporosis 6 month later
Ovarian failure caused by chemotherapy can accelerate bone loss in breast cancer patients[2,3,4,5]
Summary
Breast cancer is the most common malignant tumor in women. With the advancement of treatment, the breast cancer survival rate has dramatically increased and patients’ life extended. Maintenance of the bone health became one of the most important factors for high quality life of patients. Cancer therapies employing chemotherapeutic reagents such as aromatase inhibitors [1] were shown to adversely affect bone health, increasing the risk of osteoporosis and even fracture. Ovarian failure caused by chemotherapy can accelerate bone loss in breast cancer patients[2,3,4,5]. Some chemotherapeutic drugs including cyclophosphamide, methotrexate, 5-fluorouracil and doxorubicin have been shown to damage ovary and cause a reduction in bone volume[2,6,7]. There is no data whether chemotherapeutic drugs are effecting bone metabolism in early phase breast cancer interventions. To evaluate effects of neoadjuvant chemotherapy on the bone turnover markers of preoperational breast cancer patients. Academic Editor: Xiaoan Liu, The First Affiliated Hospital with Nanjing Medical University, CHINA
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