Risks of Aromatase Inhibitor-Related Cardiotoxicity in Patients with Breast Cancer in Asia.

Wei-Ting Chang,Yu-Hsuan Kuo,Po-Wei Chen,Sheng-Hsiang Lin,Yi-Heng Li,Hui-Wen Lin

doi:10.3390/cancers14030508

Abstract

Simple SummaryIn Asian breast cancer patients, whether the risks of major adverse cardio- and cerebrovascular events (MACCEs) are different between users of aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs) remains uncertain. In this nationwide cohort study, the risks of MACCEs were significantly higher in users of SERMs compared with users of AIs in those who were at an old age (above 50 years old) or with advanced cancer stage (stage 3–4). Although the choice of hormone therapies is primarily based on the effectiveness regarding cancer survival, AI treatment should be considered for patients for whom the benefits outweigh the risks.Background: Despite a preferred endocrine therapy for women with estrogen and progesterone receptor-positive breast cancer, aromatase inhibitors (AIs) have been reported to increase risks of cardiovascular events. Given that breast cancer patients in Asia are younger at diagnosis, it is urgent to investigate this safety concern. Methods: Through the Taiwanese National Cohort, we identified breast cancer patients initiating selective estrogen receptor modulators (SERMs) or AIs from 2010 to 2016. Outcomes includes major adverse cardio- and cerebrovascular events (MACCEs). The average follow-up duration was five years. Results: We identified 16,730 breast cancer patients treated with SERMs and 11,728 receiving AIs. The population was older and had more comorbidities in the AI group than in the SERM group. After adjusting for age, cancer stage, cancer therapies, cardiovascular drugs and comorbidities, despite similar risks of MACCEs between AI and SERM users, the risk of HF was significantly higher in patients treated with SERMs after adjusted mortality as a competing risk. When divided by the age of 50 years, despite a similar MACCEs in the younger population, MACCEs remained significantly higher in the older population who received SERMs. Conclusions: In this Asian cohort, we found that among patients of old age or with advanced cancer stage, the use of SERMs was associated with a higher risk of cardiovascular events than the use of AIs.

Highlights

With the improvement of anticancer therapies, the number of long-term cancer survivors of breast cancer has increased, but survivors face threats of cardiovascular complications, including heart failure (HF) and thromboembolic events [1,2]
Using the National Health Insurance Research Database (NHIRD) from 2010 to 2016, we identified 116152 patients newly diagnosed with breast cancer
In terms of cancer stage and treatment, more patients who received aromatase inhibitors (AIs) were at an advanced cancer stage than those who received SERMS (19.8% vs. 6.07%), while more selective estrogen receptor modulators (SERMs) users were treated with anthracyclines (23.93%), and AI users were treated with taxanes (30.98%)

Summary

Introduction

With the improvement of anticancer therapies, the number of long-term cancer survivors of breast cancer has increased, but survivors face threats of cardiovascular complications, including heart failure (HF) and thromboembolic events [1,2]. Emerging evidence reports a potential risk of major adverse cardio- and cerebrovascular events (MACCEs) with AI use compared with tamoxifen, a most frequently used SERM, use [6,7,8,9]. Despite a preferred endocrine therapy for women with estrogen and progesterone receptor-positive breast cancer, aromatase inhibitors (AIs) have been reported to increase risks of cardiovascular events. After adjusting for age, cancer stage, cancer therapies, cardiovascular drugs and comorbidities, despite similar risks of MACCEs between AI and SERM users, the risk of HF was significantly higher in patients treated with SERMs after adjusted mortality as a competing risk. When divided by the age of 50 years, despite a similar MACCEs in the younger population, MACCEs remained significantly higher in the older population who received SERMs

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